Basic Information
| Provider Information | |||||||||
| NPI: | 1093746562 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TRINITY HOME HEALTH SERVICES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SAINT JOSEPH VNA HOME CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9185 | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483339185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7343436570 | ||||||||
| FaxNumber: | 7343436451 | ||||||||
| Practice Location | |||||||||
| Address1: | 3838 N MAIN ST | ||||||||
| Address2: | STE 100 | ||||||||
| City: | MISHAWAKA | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465453100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5743358600 | ||||||||
| FaxNumber: | 5743350751 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 06/15/2022 | ||||||||
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| AuthorizedOfficialLastName: | MCPHERSON | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7343432646 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 202117 | 01 | IN | CSHCS - PLYMOUTH OFFICE | OTHER | 000000355403 | 01 | IN | ANTHEM BLUE CROSS BLUE SH | OTHER | 0007931770 | 01 | IN | AETNA | OTHER | 021236800 | 01 | IN | DEPT OF LABOR BLACK LUNG | OTHER | 100272270A | 05 | IN | MEDICAID | 202118 | 01 | IN | CSHCS - MISHAWAKA OFFICE | OTHER | 351568821-003 | 01 | IN | HUMANA | OTHER |