Healthcare Provider Details

I. General information

NPI: 1811172877
Provider Name (Legal Business Name): TRINITY VISITING NURSE AND HOMECARE ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 12/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 19TH AVE SUITE 101
MOLINE IL
61265-3700
US

IV. Provider business mailing address

106 19TH AVE SUITE 101
MOLINE IL
61265-3700
US

V. Phone/Fax

Practice location:
  • Phone: 309-779-7600
  • Fax: 309-779-7252
Mailing address:
  • Phone: 309-779-7600
  • Fax: 309-779-7252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.004883
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number05255
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209003631
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number062587
License Number StateIA
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209-005341
License Number StateIL

VIII. Authorized Official

Name: MR. TODD J RICHARD
Title or Position: EXECUTIVE DIRECTOR
Credential: PT
Phone: 309-779-7242