Provider Demographics
NPI:1386182152
Name:TRINITY CARE XYZ
Entity Type:Organization
Organization Name:TRINITY CARE XYZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:OBIRI-YEBOAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-496-5778
Mailing Address - Street 1:32 CARNWATH CT
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-1941
Mailing Address - Country:US
Mailing Address - Phone:718-496-5778
Mailing Address - Fax:973-388-7168
Practice Address - Street 1:32 CARNWATH CT
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-1941
Practice Address - Country:US
Practice Address - Phone:718-496-5778
Practice Address - Fax:973-388-7168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0250900251E00000X, 320700000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No251E00000XAgenciesHome Health
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities