Provider Demographics
NPI:1972741239
Name:TRIDENT HOME HEALTHCARE SERVICES
Entity type:Organization
Organization Name:TRIDENT HOME HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:TRANG
Authorized Official - Middle Name:THI
Authorized Official - Last Name:CHE
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:714-657-2571
Mailing Address - Street 1:87 FALLINGSTAR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-7508
Mailing Address - Country:US
Mailing Address - Phone:714-657-2571
Mailing Address - Fax:
Practice Address - Street 1:17264 RED HILL AVE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-5628
Practice Address - Country:US
Practice Address - Phone:949-724-0011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-25
Last Update Date:2009-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC2773103251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health