Provider Demographics
NPI:1851890214
Name:TRINITY HOME CARE SERVICE
Entity Type:Organization
Organization Name:TRINITY HOME CARE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NELLIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-347-7455
Mailing Address - Street 1:114 CREEKMORE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-8013
Mailing Address - Country:US
Mailing Address - Phone:662-822-9134
Mailing Address - Fax:
Practice Address - Street 1:730 MAIN ST STE I
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-4107
Practice Address - Country:US
Practice Address - Phone:662-347-7455
Practice Address - Fax:662-702-5022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care