Basic Information
| Provider Information | |||||||||
| NPI: | 1467466078 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TRINITY HOME HEALTH SERVICES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TRINITY HEALTH OF NEW ENGLAND AT HOME | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9185 | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483339185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7343436512 | ||||||||
| FaxNumber: | 7343436451 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 HILLSIDE CIR STE 2 | ||||||||
| Address2: | |||||||||
| City: | WEST SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135360503 | ||||||||
| FaxNumber: | 4135386974 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 06/15/2022 | ||||||||
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| AuthorizedOfficialLastName: | MCPHERSON | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7343432646 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | MA | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 612870 | 01 | MA | TUFTS | OTHER | 110024474A | 05 | MA | MEDICAID | 120441 | 01 | MA | BLUE CROSS | OTHER | 0606987 | 05 | MA | MEDICAID |