1992729636 NPI number — TRINITY VISITING NURSE AND HOMECARE ASSOCIATION

Table of content: (NPI 1992729636)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992729636 NPI number — TRINITY VISITING NURSE AND HOMECARE ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRINITY VISITING NURSE AND HOMECARE ASSOCIATION
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:
Provider Other Organization Name Type Code:
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:
1992729636
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2010
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 101
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:
309-779-7600
Provider Business Mailing Address Fax Number:
309-779-7252

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 19TH AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
MOLINE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61265-3700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-779-7600
Provider Business Practice Location Address Fax Number:
309-779-7252
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RICHARD
Authorized Official First Name:
TODD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
309-779-7242

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  1002237 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0908434 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 96359 . This is a "WELLMARK IA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9691 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 96360 . This is a "WELLMARK" identifier . This identifiers is of the category "OTHER".




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