Provider Demographics
NPI:1811358864
Name:THOMAS, TRENT
Entity type:Individual
Prefix:MR
First Name:TRENT
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36266
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27416-6266
Mailing Address - Country:US
Mailing Address - Phone:336-965-7186
Mailing Address - Fax:888-821-5068
Practice Address - Street 1:1607 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-2423
Practice Address - Country:US
Practice Address - Phone:336-965-7186
Practice Address - Fax:888-821-5068
Is Sole Proprietor?:No
Enumeration Date:2016-03-17
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172A00000X, 175T00000X
NC430176372500000X, 374U00000X
NC2018-5019-01175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No172A00000XOther Service ProvidersDriver
No372500000XNursing Service Related ProvidersChore Provider
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2018-5019-01OtherNCCPSS
NC246915141OMedicaid