MEDICARE: TRINITY HEALTH CARE SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	22915338	MO
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1679087753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY HEALTH CARE SERVICES

Provider Business Mailing Address
First Line	:	11 DAWNRIDGE DR
Second Line	:
City	:	HAZELWOOD
State	:	MO
Zip	:	63042-2674
Country	:	US
Telephone Number	:	314-548-9209
Fax Number	:

Provider Business Practice Location Address
First Line	:	1033 CORPORATE SQUARE DR STE 125
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-2928
Country	:	US
Telephone Number	:	314-548-9209
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	JANE MWANGI
Credential	:
Telephone Number	:	314-548-9209

Provider Enumeration Date	:	11/27/2017
Last Update Date	:	12/27/2017

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Directions to “TRINITY HEALTH CARE SERVICES ” Practice Location

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