Healthcare Provider Details

I. General information

NPI: 1851522965
Provider Name (Legal Business Name): TRINITYCARE GROUP HOMES INDIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N MERIDIAN ST SUITE 403
INDIANAPOLIS IN
46202-1443
US

IV. Provider business mailing address

1800 N MERIDIAN ST SUITE 403
INDIANAPOLIS IN
46202-1443
US

V. Phone/Fax

Practice location:
  • Phone: 317-924-8405
  • Fax: 317-924-8409
Mailing address:
  • Phone: 317-924-8405
  • Fax: 317-924-8409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number43858
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number43858
License Number StateIN

VIII. Authorized Official

Name: MS. TRINETTE CLARK
Title or Position: PRESIDENT/ADMINISTRATOR
Credential: B.S., A.S.C.P.
Phone: 317-924-5804