Basic Information
Provider Information | |||||||||
NPI: | 1568654093 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | TRINITY HOSPICE OF VIRGINIA, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
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OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 14180 DALLAS PKWY | ||||||||
Address2: | SUITE 800 | ||||||||
City: | DALLAS | ||||||||
State: | TX | ||||||||
PostalCode: | 752544341 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2143064520 | ||||||||
FaxNumber: | 2144329220 | ||||||||
Practice Location | |||||||||
Address1: | 8300 BOONE BLVD | ||||||||
Address2: | SUITE 850 | ||||||||
City: | VIENNA | ||||||||
State: | VA | ||||||||
PostalCode: | 221822626 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7037903234 | ||||||||
FaxNumber: | 7037903631 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/17/2007 | ||||||||
LastUpdateDate: | 08/17/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | GLASSCOCK | ||||||||
AuthorizedOfficialFirstName: | AMY | ||||||||
AuthorizedOfficialMiddleName: | M | ||||||||
AuthorizedOfficialTitleorPosition: | A/R MANAGER | ||||||||
AuthorizedOfficialTelephone: | 2143064520 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
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AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X |   |   | Y |   | Agencies | Hospice Care, Community Based |   |
No ID Information.