Healthcare Provider Details

I. General information

NPI: 1649692815
Provider Name (Legal Business Name): TRINITY COMPANION CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2014
Last Update Date: 01/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16700 SWANSON COVE CT
HUGHESVILLE MD
20637-2804
US

IV. Provider business mailing address

16700 SWANSON COVE CT
HUGHESVILLE MD
20637-2804
US

V. Phone/Fax

Practice location:
  • Phone: 240-538-6122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberW15615420
License Number StateMD

VIII. Authorized Official

Name: PETRA PATTERSON
Title or Position: CO-FOUNDER, DIRECTOR OF NURSING
Credential:
Phone: 240-538-6122