Healthcare Provider Details

I. General information

NPI: 1073182762
Provider Name (Legal Business Name): TRINITY HOME CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3102 GOLANSKY BLVD STE 201
WOODBRIDGE VA
22192-4244
US

IV. Provider business mailing address

3102 GOLANSKY BLVD STE 201
WOODBRIDGE VA
22192-4244
US

V. Phone/Fax

Practice location:
  • Phone: 571-398-6736
  • Fax:
Mailing address:
  • Phone: 571-398-6736
  • Fax: 703-436-9434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CHIKATA KHYNE-SAM
Title or Position: OWNER
Credential:
Phone: 571-398-6736