Healthcare Provider Details

I. General information

NPI: 1578165494
Provider Name (Legal Business Name): TRI-COUNTY GROUP XV, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3165 MCKELVEY RD STE 203A
BRIDGETON MO
63044-2550
US

IV. Provider business mailing address

14295 MIDWAY RD STE 400
ADDISON TX
75001-3678
US

V. Phone/Fax

Practice location:
  • Phone: 314-837-8324
  • Fax: 314-837-8677
Mailing address:
  • Phone: 903-537-8656
  • Fax: 903-537-8420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KATIE MONASTIERE
Title or Position: COMPLIANCE AND PRIVACY OFFICER
Credential:
Phone: 517-768-4373