Healthcare Provider Details

I. General information

NPI: 1356515522
Provider Name (Legal Business Name): TRINITY CARE GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 LINCOLN HIGHWAY SUITE 209
OLYMPIA FIELDS IL
60461-1939
US

IV. Provider business mailing address

2555 LINCOLN HIGHWAY SUITE 209
OLYMPIA FIELDS IL
60461-1939
US

V. Phone/Fax

Practice location:
  • Phone: 708-748-4661
  • Fax: 708-748-4667
Mailing address:
  • Phone: 708-748-4661
  • Fax: 708-748-4667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. PATRICK PAUL UDONKANG
Title or Position: PRESIDENT
Credential:
Phone: 708-748-4661