Provider Demographics
NPI:1821248519
Name:TRINITY HOME HEALTH CARE SERVICES
Entity Type:Organization
Organization Name:TRINITY HOME HEALTH CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ETYANE
Authorized Official - Middle Name:MAMO
Authorized Official - Last Name:AYANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-465-1959
Mailing Address - Street 1:17305 CEDAR AVE S
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-3901
Mailing Address - Country:US
Mailing Address - Phone:952-465-1959
Mailing Address - Fax:952-236-0138
Practice Address - Street 1:17305 CEDAR AVE S STE 220
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-3903
Practice Address - Country:US
Practice Address - Phone:952-465-1959
Practice Address - Fax:952-236-0138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN339721251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health