Provider Demographics
NPI:1750127478
Name:TRINITY HEALTH PACE MONTGOMERY COUNTY
Entity type:Organization
Organization Name:TRINITY HEALTH PACE MONTGOMERY COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:240-690-3456
Mailing Address - Street 1:200 PERRY PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2171
Mailing Address - Country:US
Mailing Address - Phone:240-690-3456
Mailing Address - Fax:
Practice Address - Street 1:200 PERRY PKWY STE 1
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2171
Practice Address - Country:US
Practice Address - Phone:240-690-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY HEALTH PACE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization