1093746562 NPI number — TRINITY HOME HEALTH SERVICES

Table of content: (NPI 1093746562)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093746562 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:
Provider Other Organization Name Type Code:
6
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:
1093746562
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 532020
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIVONIA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48153-2020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-827-0788
Provider Business Mailing Address Fax Number:
734-343-6451

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
707 CEDAR ST STE 320
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH BEND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46617-2054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-335-8600
Provider Business Practice Location Address Fax Number:
574-335-0751
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0007931770 . This is a "AETNA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 021236800 . This is a "DEPT OF LABOR BLACK LUNG" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 202117 . This is a "CSHCS - PLYMOUTH OFFICE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 351568821-003 . This is a "HUMANA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 202118 . This is a "CSHCS - MISHAWAKA OFFICE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000355403 . This is a "ANTHEM BLUE CROSS BLUE SH" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100272270A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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