MEDICARE: EDWARDS-TRINITY HEALTHCARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	011348	TX

General Provider Information

NPI Number	:	1114225364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDWARDS-TRINITY HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	9696 SKILLMAN ST
Second Line	:	STE. 225
City	:	DALLAS
State	:	TX
Zip	:	75243-8264
Country	:	US
Telephone Number	:	214-622-2513
Fax Number	:	214-553-5138

Provider Business Practice Location Address
First Line	:	9696 SKILLMAN ST
Second Line	:	STE. 225
City	:	DALLAS
State	:	TX
Zip	:	75243-8264
Country	:	US
Telephone Number	:	214-622-2513
Fax Number	:	214-553-5138

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. PAULLY N OKEA SR.
Credential	:
Telephone Number	:	214-622-2513

Provider Enumeration Date	:	03/10/2011
Last Update Date	:	03/11/2011

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