Basic Information
| Provider Information | |||||||||
| NPI: | 1285881466 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CSRA HOLDINGS LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TRINITY HOME SERVICES CENTER FOR HOSPICE PALLIATIVE CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 690 MEDICAL PARK DR | ||||||||
| Address2: | STE 400 | ||||||||
| City: | AIKEN | ||||||||
| State: | SC | ||||||||
| PostalCode: | 298016348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067296000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 690 MEDICAL PARK DR | ||||||||
| Address2: | STE 400 | ||||||||
| City: | AIKEN | ||||||||
| State: | SC | ||||||||
| PostalCode: | 298016348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067296000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2008 | ||||||||
| LastUpdateDate: | 02/25/2015 | ||||||||
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| AuthorizedOfficialLastName: | HOLTSFORD | ||||||||
| AuthorizedOfficialFirstName: | LAURIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUHTORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 6154657466 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CSRA HOLDINGS LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | SC | Y | Agencies | Hospice Care, Community Based |
No ID Information.