Provider Demographics
NPI:1891712691
Name:BLESSED TRINITY HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:BLESSED TRINITY HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:913-721-9856
Mailing Address - Street 1:1400 S 130TH ST
Mailing Address - Street 2:
Mailing Address - City:BONNER SPRINGS
Mailing Address - State:KS
Mailing Address - Zip Code:66012-9241
Mailing Address - Country:US
Mailing Address - Phone:913-721-9856
Mailing Address - Fax:913-721-9858
Practice Address - Street 1:1400 S 130TH ST
Practice Address - Street 2:
Practice Address - City:BONNER SPRINGS
Practice Address - State:KS
Practice Address - Zip Code:66012-9241
Practice Address - Country:US
Practice Address - Phone:913-721-9856
Practice Address - Fax:913-721-9858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSA052008251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200266190AMedicaid
KS200266190AMedicaid