1295917706 NPI number — TRINITY CONTINUING CARE SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295917706 NPI number — TRINITY CONTINUING CARE SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRINITY CONTINUING CARE SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MERCY SERVICES FOR AGING
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295917706
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9184
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48333-9184
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-305-7767
Provider Business Mailing Address Fax Number:
248-305-7677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39500 ORCHARD HILL PL
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
NOVI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48375-5370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-305-7767
Provider Business Practice Location Address Fax Number:
248-305-7677
Provider Enumeration Date:
11/27/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
JACKIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
248-305-7688

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 521945054 . This is a "TAX ID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 930907047 . This is a "TAX ID" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 382719605 . This is a "TAX ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".