Provider Demographics
NPI:1962464032
Name:TRINICARE HOME HEALTH, INC
Entity Type:Organization
Organization Name:TRINICARE HOME HEALTH, INC
Other - Org Name:MICHELLE HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUDREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:BS BA
Authorized Official - Phone:469-828-1132
Mailing Address - Street 1:1222 E ARAPAHO RD
Mailing Address - Street 2:322
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-2478
Mailing Address - Country:US
Mailing Address - Phone:469-828-1132
Mailing Address - Fax:469-828-1074
Practice Address - Street 1:1222 E ARAPAHO RD
Practice Address - Street 2:322
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-2478
Practice Address - Country:US
Practice Address - Phone:469-828-1132
Practice Address - Fax:469-828-1074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007996251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX007996OtherSTATE LICENSE NUMBER
TX67-9214OtherPTAN