Provider Demographics
NPI:1942365499
Name:TRINITY HOME CARE OF ROBESON COUNTY
Entity Type:Organization
Organization Name:TRINITY HOME CARE OF ROBESON COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKLEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-844-7049
Mailing Address - Street 1:603 W MLK JR DR
Mailing Address - Street 2:TRINITY HOME CARE OF ROBESON COUNTY
Mailing Address - City:MAXTON
Mailing Address - State:NC
Mailing Address - Zip Code:28364-1845
Mailing Address - Country:US
Mailing Address - Phone:910-844-7049
Mailing Address - Fax:910-844-7049
Practice Address - Street 1:603 W MLK JR DR
Practice Address - Street 2:
Practice Address - City:MAXTON
Practice Address - State:NC
Practice Address - Zip Code:28364-1845
Practice Address - Country:US
Practice Address - Phone:910-844-7049
Practice Address - Fax:910-844-7049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3118251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601345Medicaid
NC3418025Medicaid