Provider Demographics
NPI:1447242623
Name:TRINITY HOME HEALTH SERVICES
Entity Type:Organization
Organization Name:TRINITY HOME HEALTH SERVICES
Other - Org Name:ST MARY'S HOSPICE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-283-4006
Mailing Address - Street 1:PO BOX 6588
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30604-6588
Mailing Address - Country:US
Mailing Address - Phone:706-389-2273
Mailing Address - Fax:706-208-8883
Practice Address - Street 1:1021 JAMESTOWN BLVD
Practice Address - Street 2:STE 215
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-4139
Practice Address - Country:US
Practice Address - Phone:706-389-2273
Practice Address - Fax:706-208-8883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029035H251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111525Medicare Oscar/Certification