1689758575 NPI number — TRINITY CONTINUING CARE SERVICES

Table of content: (NPI 1689758575)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689758575 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:
1689758575
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9184
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48333-9184
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-305-7919
Provider Business Mailing Address Fax Number:
248-305-7677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17475 DUGDALE DR
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:
46635-1545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-291-3990
Provider Business Practice Location Address Fax Number:
219-271-3981
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
JACKIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
248-305-7688

Provider Taxonomy Codes

  • Taxonomy code: 332BN1400X , with the licence number:  05-001201 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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