Provider Demographics
NPI:1073510350
Name:TRINITY PROFESSIONAL HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:TRINITY PROFESSIONAL HEALTH SERVICES, INC.
Other - Org Name:ESSENTIAL HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:314-398-1458
Mailing Address - Street 1:9191 W FLORISSANT AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-1424
Mailing Address - Country:US
Mailing Address - Phone:314-522-6000
Mailing Address - Fax:314-522-6001
Practice Address - Street 1:9191 W FLORISSANT AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-1424
Practice Address - Country:US
Practice Address - Phone:314-521-0697
Practice Address - Fax:314-522-2053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00010664163WH0200X
163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO584585104Medicaid
MO267557-AMedicare ID - Type UnspecifiedPROVIDER NUMBER