Provider Demographics
NPI:1700053121
Name:TRINITY HEALTHCARE, INC.
Entity Type:Organization
Organization Name:TRINITY HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:FABUGAIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:574-223-4663
Mailing Address - Street 1:114 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:46975-1747
Mailing Address - Country:US
Mailing Address - Phone:574-223-4663
Mailing Address - Fax:574-223-1663
Practice Address - Street 1:114 E 10TH ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:IN
Practice Address - Zip Code:46975-1747
Practice Address - Country:US
Practice Address - Phone:574-223-4663
Practice Address - Fax:574-223-1663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN15Q7607001OtherVALPARAISO, IN BRANCH MEDICARE #
IN200926460AMedicaid
IN200926460AMedicaid