Provider Demographics
NPI:1225067903
Name:TRINITY HEALTH ENTERPRISES, INC.
Entity Type:Organization
Organization Name:TRINITY HEALTH ENTERPRISES, INC.
Other - Org Name:TRINITY HOME CARE PRODUCTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAUWELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-779-5630
Mailing Address - Street 1:106 19TH AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-3700
Mailing Address - Country:US
Mailing Address - Phone:309-779-4663
Mailing Address - Fax:309-779-5644
Practice Address - Street 1:106 19TH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-3700
Practice Address - Country:US
Practice Address - Phone:309-779-4663
Practice Address - Fax:309-779-5644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203-000155332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
605197300OtherDEPARTMENT OF LABOR
IL08170524OtherBLUE CROSS BLUE SHIELD IL
IL029270OtherHEALTH ALLIANCE
IA0994046Medicaid
IA96467OtherWELLMARK BCBS OF IA
IL08170524OtherBLUE CROSS BLUE SHIELD IL
IL029270OtherHEALTH ALLIANCE
IL029270OtherHEALTH ALLIANCE
605197300OtherDEPARTMENT OF LABOR