MEDICARE: TRINOR CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376G00000X	Nursing Home Administrator

General Provider Information

NPI Number	:	1891381380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINOR CARE LLC

Provider Business Mailing Address
First Line	:	3600 W DUBLIN ST
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85226-5911
Country	:	US
Telephone Number	:	480-203-5047
Fax Number	:

Provider Business Practice Location Address
First Line	:	3600 W DUBLIN ST
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85226-5911
Country	:	US
Telephone Number	:	480-203-5047
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR/CEO
Name	:	MR. HENRY IKECHUKWU IBEH
Credential	:
Telephone Number	:	480-203-5047

Provider Enumeration Date	:	12/18/2020
Last Update Date	:	12/18/2020

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