MEDICARE: TRINITY HOSPICE OF OHIO, LLC

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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1861684383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY HOSPICE OF OHIO, LLC

Provider Business Mailing Address
First Line	:	14180 DALLAS PKWY
Second Line	:	SUITE 800
City	:	DALLAS
State	:	TX
Zip	:	75254-4341
Country	:	US
Telephone Number	:	214-306-4500
Fax Number	:	214-432-9220

Provider Business Practice Location Address
First Line	:	9100 S HILLS BLVD
Second Line	:	SUITE 220
City	:	BROADVIEW HEIGHTS
State	:	OH
Zip	:	44147-3518
Country	:	US
Telephone Number	:	440-740-0086
Fax Number	:	440-740-0336

Authorized Official
Title or Position	:	A/R MANAGER
Name	:	MISS AMY M GLASSCOCK
Credential	:
Telephone Number	:	214-306-4520

Provider Enumeration Date	:	08/17/2007
Last Update Date	:	08/17/2007

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