=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528362548
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRINITY HOME CARE SERVICES L.L.C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2011
-----------------------------------------------------
Last Update Date | 01/05/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7070 POPLAR DR
-----------------------------------------------------
City | YPSILANTI
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48197-1771
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-678-5469
-----------------------------------------------------
Fax | 734-547-0933
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9570 W HEREFORD DR
-----------------------------------------------------
City | YPSILANTI
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48197-1875
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-678-5469
-----------------------------------------------------
Fax | 734-547-5433
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. ROBBYN SMITH
-----------------------------------------------------
Credential | R.N
-----------------------------------------------------
Telephone | 734-678-0725
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------