1174510952 NPI number — TRINITY CONTINUING CARE SERVICES

Table of content: (NPI 1174510952)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174510952 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:
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:
1174510952
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17410 COLLEGE PKWY
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
LIVONIA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48152-2369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-542-8300
Provider Business Mailing Address Fax Number:
734-542-8383

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
849 13TH AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52732-5168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-242-1521
Provider Business Practice Location Address Fax Number:
563-243-3016
Provider Enumeration Date:
10/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GOSIK
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
734-542-8366

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  N-192 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0800086 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com