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General NPI Number Information
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NPI Number | 1629629605
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Entity Type | Organization
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Legal Business Name | TRINITY LIVING PROVIDER SERVICES LLC
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Dates
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Enumeration Date | 09/22/2019
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Last Update Date | 05/18/2020
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Provider Practice Location Address
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Address Line | 12677 HIRAM CLARKE RD
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City | HOUSTON
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State | TX
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Zip | 77045-2218
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Country | US
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Telephone | 832-591-6836
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 450133
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City | HOUSTON
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State | TX
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Zip | 77245-0133
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Country | US
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Telephone | 832-368-0946
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. CHARLENE LEE OKENDU
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Credential | ADMINISTRATOR
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Telephone | 832-368-0946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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