Healthcare Provider Details

I. General information

NPI: 1912484890
Provider Name (Legal Business Name): TRILLIUM HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 E THOMAS RD STE 201
PHOENIX AZ
85016-7818
US

IV. Provider business mailing address

2345 E THOMAS RD STE 201
PHOENIX AZ
85016-7818
US

V. Phone/Fax

Practice location:
  • Phone: 602-956-1711
  • Fax: 602-956-5232
Mailing address:
  • Phone: 602-956-1711
  • Fax: 602-956-5232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: ROSEMARIE ANNE FRIEND
Title or Position: CEO
Credential:
Phone: 602-956-1711