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General NPI Number Information
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NPI Number | 1922596923
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Entity Type | Organization
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Legal Business Name | TRINITY HOME CARE LLC
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Dates
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Enumeration Date | 04/25/2018
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Last Update Date | 04/25/2018
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Provider Practice Location Address
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Address Line | 1608 #B STATE HIGHWAY 264
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City | TSE BONITO
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State | NM
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Zip | 87305
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Country | US
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Telephone | 505-900-8894
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 94
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City | ST MICHAELS
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State | AZ
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Zip | 86511-0094
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Country | US
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Telephone | 928-871-5208
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Fax | 888-481-6796
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Authorized Official
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Title or Position | OWNER
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Name | SUE ANN MANUELITO
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Credential | EDD
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Telephone | 505-900-8894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 102334
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License Number State | AZ
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