1467546655 NPI number — TRINITY CONTINUING CARE SERVICES

Table of content: (NPI 1467546655)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467546655 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:
SANCTUARY AT FRASER
Provider Other Organization Name Type Code:
3
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:
1467546655
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2022
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:
734-542-8300
Provider Business Mailing Address Fax Number:
735-542-8384

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33300 UTICA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRASER
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48026-2017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-293-3300
Provider Business Practice Location Address Fax Number:
586-293-6949
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LATOVICK
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
SUE
Authorized Official Title or Position:
VICE PRESIDENT REIMBURSEMENT
Authorized Official Telephone Number:
734-343-6628

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  504013 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 504013 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 09961 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 60-2627365 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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