Provider Demographics
NPI:1336370287
Name:TRINIDAD PHC
Entity Type:Organization
Organization Name:TRINIDAD PHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRAZEMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-748-2657
Mailing Address - Street 1:P.O. BOX 247
Mailing Address - Street 2:
Mailing Address - City:RIO HONDO
Mailing Address - State:TX
Mailing Address - Zip Code:78583-0247
Mailing Address - Country:US
Mailing Address - Phone:956-748-2657
Mailing Address - Fax:956-748-2667
Practice Address - Street 1:102 E. COLORADO AVE.
Practice Address - Street 2:
Practice Address - City:RIO HONDO
Practice Address - State:TX
Practice Address - Zip Code:78583-0247
Practice Address - Country:US
Practice Address - Phone:956-748-2657
Practice Address - Fax:956-748-2667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care