1447242623 NPI number — TRINITY HOME HEALTH 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 1447242623 NPI number — TRINITY HOME HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRINITY HOME HEALTH 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:
ST MARY'S HOSPICE SERVICES
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:
1447242623
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6588
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATHENS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30604-6588
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-389-2273
Provider Business Mailing Address Fax Number:
706-208-8883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1021 JAMESTOWN BLVD
Provider Second Line Business Practice Location Address:
STE 215
Provider Business Practice Location Address City Name:
WATKINSVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30677-4139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-389-2273
Provider Business Practice Location Address Fax Number:
706-208-8883
Provider Enumeration Date:
08/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BOWENS
Authorized Official First Name:
MARCUS
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMIN
Authorized Official Telephone Number:
770-283-4006

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  029035H , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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