MEDICARE: TRINITY II HOME CARE

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	253Z00000X	In Home Supportive Care Agency	25163601	PA

General Provider Information

NPI Number	:	1336569110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY II HOME CARE

Provider Business Mailing Address
First Line	:	1231 N BROAD ST
Second Line	:	4TH FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-4021
Country	:	US
Telephone Number	:	267-332-1227
Fax Number	:

Provider Business Practice Location Address
First Line	:	1231 N BROAD ST
Second Line	:	4TH FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-4021
Country	:	US
Telephone Number	:	267-332-1227
Fax Number	:

Authorized Official
Title or Position	:	COMPLIANCE DIRECTOR
Name	:	MRS. GAIL SMALLS
Credential	:	MHS
Telephone Number	:	267-332-1227

Provider Enumeration Date	:	04/21/2014
Last Update Date	:	04/21/2014

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