Provider Demographics
NPI:1790873149
Name:TRINITY HOME HEALTH SERVICES
Entity Type:Organization
Organization Name:TRINITY HOME HEALTH SERVICES
Other - Org Name:SAINT AGNES HOME HEALTH AND HOSPICE, LLC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
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 532020
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48153-2020
Mailing Address - Country:US
Mailing Address - Phone:877-827-0788
Mailing Address - Fax:734-343-6451
Practice Address - Street 1:6729 N WILLOW AVE
Practice Address - Street 2:STE103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5952
Practice Address - Country:US
Practice Address - Phone:559-450-5112
Practice Address - Fax:559-450-5694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA040000174251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA07135FMedicaid
057135Medicare Oscar/Certification