MEDICARE: TRINITY HOSPICE, LLC

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	251G00000X	Community Based Hospice Care Agency	4135	OK

General Provider Information

NPI Number	:	1467403550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY HOSPICE, LLC

Provider Business Mailing Address
First Line	:	14180 DALLAS PKWY
Second Line	:	SUITE 800
City	:	DALLAS
State	:	TX
Zip	:	75254-4341
Country	:	US
Telephone Number	:	214-306-4520
Fax Number	:	972-386-0704

Provider Business Practice Location Address
First Line	:	201 W OKMULGEE AVE
Second Line	:
City	:	CHECOTAH
State	:	OK
Zip	:	74426-2408
Country	:	US
Telephone Number	:	918-473-0505
Fax Number	:	972-386-0704

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	AMY MARIE WHITLEY
Credential	:
Telephone Number	:	214-306-4520

Provider Enumeration Date	:	05/13/2006
Last Update Date	:	08/22/2020

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