Provider Demographics
NPI:1851522965
Name:TRINITYCARE GROUP HOMES INDIANA
Entity Type:Organization
Organization Name:TRINITYCARE GROUP HOMES INDIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TRINETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:BS, ASCP
Authorized Official - Phone:317-924-5804
Mailing Address - Street 1:1800 N MERIDIAN ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1443
Mailing Address - Country:US
Mailing Address - Phone:317-924-8405
Mailing Address - Fax:317-924-8409
Practice Address - Street 1:1800 N MERIDIAN ST
Practice Address - Street 2:SUITE 403
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1443
Practice Address - Country:US
Practice Address - Phone:317-924-8405
Practice Address - Fax:317-924-8409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN43858311Z00000X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child