Provider Demographics
NPI:1740557404
Name:TRINITY HOME CARE AGENCY
Entity Type:Organization
Organization Name:TRINITY HOME CARE AGENCY
Other - Org Name:TRINITY HOME CARE AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/EXECTIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALETTA
Authorized Official - Middle Name:G
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED CARE GIVER
Authorized Official - Phone:480-245-8698
Mailing Address - Street 1:1420 W PEORIA AVE
Mailing Address - Street 2:SUITE 213
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-5170
Mailing Address - Country:US
Mailing Address - Phone:480-245-8698
Mailing Address - Fax:602-943-4972
Practice Address - Street 1:1420 W PEORIA AVE
Practice Address - Street 2:SUITE 213
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-5170
Practice Address - Country:US
Practice Address - Phone:480-245-8698
Practice Address - Fax:602-943-4972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALTP0136253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ24OtherNON -MEDICAL PROVIDER