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General NPI Number Information
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NPI Number | 1497211106
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Entity Type | Organization
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Legal Business Name | TRINITYS PROMISE HEALTHCARE LLC.
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Dates
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Enumeration Date | 02/18/2019
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Last Update Date | 02/18/2019
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Provider Practice Location Address
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Address Line | 500 W SILVER SPRING DR STE K200
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City | MILWAUKEE
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State | WI
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Zip | 53217-5052
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Country | US
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Telephone | 414-460-0145
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Fax |
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Provider Business Mailing Address
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Address Line | 7641 N 60TH ST APT 104
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City | MILWAUKEE
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State | WI
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Zip | 53223-4137
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | TRINITY A LITTLE
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Credential |
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Telephone | 414-460-0145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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