Provider Demographics
NPI: | 1689417867 |
---|---|
Name: | TRENDSTONE SOUTH |
Entity type: | Organization |
Organization Name: | TRENDSTONE SOUTH |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | NURSE |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KALIA |
Authorized Official - Middle Name: | COLETTE |
Authorized Official - Last Name: | LUCAS-SMITH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 404-839-2107 |
Mailing Address - Street 1: | 265 18TH ST NW UNIT 2334 |
Mailing Address - Street 2: | |
Mailing Address - City: | ATLANTA |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30363-1153 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 404-839-2107 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 265 18TH ST NW UNIT 2334 |
Practice Address - Street 2: | |
Practice Address - City: | ATLANTA |
Practice Address - State: | GA |
Practice Address - Zip Code: | 30363-1153 |
Practice Address - Country: | US |
Practice Address - Phone: | 404-839-2107 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2024-06-17 |
Last Update Date: | 2024-06-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility | ||
No | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered | Group - Multi-Specialty | |
No | 146L00000X | Emergency Medical Service Providers | Emergency Medical Technician, Paramedic | Group - Multi-Specialty | |
No | 146N00000X | Emergency Medical Service Providers | Emergency Medical Technician, Basic | Group - Multi-Specialty | |
No | 163W00000X | Nursing Service Providers | Registered Nurse | Group - Multi-Specialty | |
No | 163WC0400X | Nursing Service Providers | Registered Nurse | Case Management | Group - Multi-Specialty |
No | 163WC1500X | Nursing Service Providers | Registered Nurse | Community Health | Group - Multi-Specialty |
No | 163WH0200X | Nursing Service Providers | Registered Nurse | Home Health | Group - Multi-Specialty |
No | 163WW0000X | Nursing Service Providers | Registered Nurse | Wound Care | Group - Multi-Specialty |
No | 164W00000X | Nursing Service Providers | Licensed Practical Nurse | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 314000000X | Nursing & Custodial Care Facilities | Skilled Nursing Facility | ||
No | 341600000X | Transportation Services | Ambulance | ||
No | 374U00000X | Nursing Service Related Providers | Home Health Aide | Group - Multi-Specialty |