MEDICARE: TRINITY ADHC, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1003463993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY ADHC, INC.

Provider Business Mailing Address
First Line	:	6200 LANKERSHIM BLVD
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-4005
Country	:	US
Telephone Number	:	818-231-0627
Fax Number	:

Provider Business Practice Location Address
First Line	:	6200 LANKERSHIM BLVD
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-4005
Country	:	US
Telephone Number	:	818-231-0627
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ERICA NASSERIAN
Credential	:
Telephone Number	:	818-231-0627

Provider Enumeration Date	:	08/24/2019
Last Update Date	:	08/24/2019

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Directions to “TRINITY ADHC, INC. ” Practice Location

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