Basic Information
| Provider Information | |||||||||
| NPI: | 1518167337 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PENNSYLVANIA TRINITY HOSPICE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14180 DALLAS PKWY | ||||||||
| Address2: | SUITE 800 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752544341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143064520 | ||||||||
| FaxNumber: | 2144329220 | ||||||||
| Practice Location | |||||||||
| Address1: | 1255 DRUMMERS LN | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | WAYNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190871565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102937413 | ||||||||
| FaxNumber: | 6102937459 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2007 | ||||||||
| LastUpdateDate: | 07/19/2007 | ||||||||
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| AuthorizedOfficialLastName: | GLASSCOCK | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2143064520 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | PA | Y | Agencies | Hospice Care, Community Based |
No ID Information.