1881963825 NPI number — TRINITY HEALTH ENTERPRISES INC

Table of content: (NPI 1881963825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881963825 NPI number — TRINITY HEALTH ENTERPRISES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRINITY HEALTH ENTERPRISES INC
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:
TRINITY HOME CARE PRODUCTS
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:
1881963825
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 19TH AVE
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
MOLINE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61265-3700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-779-4663
Provider Business Mailing Address Fax Number:
309-779-5644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2701 17TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCK ISLAND
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61201-5351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-779-5625
Provider Business Practice Location Address Fax Number:
309-779-5629
Provider Enumeration Date:
12/20/2011

Additional Information

Authorized Official

Authorized Official Last Name:
PAUWELS
Authorized Official First Name:
TAMMY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
309-779-4663

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1473011 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 08170524 . This is a "BLUE CROSS BLUE SHIELD IL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0994046 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 605197300 . This is a "DEPARTMENT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 96467 . This is a "WELLMARK BCBS OF IA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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