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General NPI Number Information
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NPI Number | 1710347661
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Entity Type | Organization
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Legal Business Name | TRINITY HEALTH LIFE PENNSYLVANIA, INC.
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Dates
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Enumeration Date | 03/03/2016
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Last Update Date | 03/03/2016
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Provider Practice Location Address
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Address Line | 4508 CHESTNUT ST
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City | PHILADELPHIA
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State | PA
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Zip | 19139-3608
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Country | US
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Telephone | 215-573-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 20255 VICTOR PKWY
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City | LIVONIA
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State | MI
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Zip | 48152-7018
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Country | US
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Telephone | 734-343-0717
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Fax | 248-347-5201
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Authorized Official
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Title or Position | VICE PRESIDENT STRATEGY AND GROWTH
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Name | MRS. ANNE M LEWIS
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Credential |
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Telephone | 406-669-3332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251T00000X
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Taxonomy Name | PACE Provider Organization
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License Number |
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License Number State |
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