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General NPI Number Information
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NPI Number | 1245383165
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Entity Type | Organization
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Legal Business Name | PROVIDENCE TRINITYCARE HOSPICE
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 5315 TORRANCE BLVD., SUITE B-1 PROVIDENCE TRINITYCARE HOSPICE
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City | TORRANCE
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State | CA
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Zip | 90503-4011
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Country | US
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Telephone | 310-543-3400
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Fax | 310-316-2350
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Provider Business Mailing Address
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Address Line | 5315 TORRANCE BLVD., SUITE B-1 PROVIDENCE TRINITYCARE HOSPICE
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City | TORRANCE
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State | CA
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Zip | 90503-4011
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Country | US
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Telephone | 310-543-3400
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Fax | 310-316-2350
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Authorized Official
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Title or Position | ASSISTANT SECRETARY FOR ENROLLMENT
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Name | DONALD W ANDERSON JR.
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Credential |
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Telephone | 425-358-9786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 980000880
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License Number State | CA
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