Provider Demographics
NPI:1356515522
Name:TRINITY CARE GROUP, LLC
Entity type:Organization
Organization Name:TRINITY CARE GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:UDONKANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-748-4661
Mailing Address - Street 1:2555 LINCOLN HIGHWAY
Mailing Address - Street 2:SUITE 209
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1939
Mailing Address - Country:US
Mailing Address - Phone:708-748-4661
Mailing Address - Fax:708-748-4667
Practice Address - Street 1:2555 LINCOLN HIGHWAY
Practice Address - Street 2:SUITE 209
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1939
Practice Address - Country:US
Practice Address - Phone:708-748-4661
Practice Address - Fax:708-748-4667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC1900X
IL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty