| Organization Name: | TRIDENTCARE HEALTH SERVICES, INC. |
| NPI Number: | 1114280922 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | VONSTONE WOLFE (CHIEF ADMINISTRATIVE OFFICER) |
| Mailing Address: | 1200 Abernathy Rd Ne Building 600, Suite 1700 Atlanta |
| State: | GA US |
| Postal Code: | 303285662 |
| Phone Number: | 6785147322 |
| Fax Number: | 6785285076 |
| NPI Enumeration Date: | 06/18/2012 |
| NPI Last Update Date: | 06/18/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 253Z00000X |
| License Number: | 060-R-1032 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | In Home Supportive Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |