Provider Demographics
NPI:1649320789
Name:TRINITY HOME HEALTH SERVICES
Entity type:Organization
Organization Name:TRINITY HOME HEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-283-4006
Mailing Address - Street 1:PO BOX 532020
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48153-2020
Mailing Address - Country:US
Mailing Address - Phone:877-827-0788
Mailing Address - Fax:734-343-6451
Practice Address - Street 1:2301 W. 22ND STREET
Practice Address - Street 2:SUITE 107
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-4104
Practice Address - Country:US
Practice Address - Phone:888-584-7888
Practice Address - Fax:630-574-2358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0004630251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9729OtherBLUE CROSS HOME INFUSION
IL1671580OtherBC FEDERAL HOME HEALTH
IL0500OtherBLUE CROSS
IL14T276Medicare ID - Type UnspecifiedREHAB
IL147257Medicare ID - Type UnspecifiedHOME HEALTH
IL140276Medicare Oscar/Certification
IL0500OtherBLUE CROSS
IL9729OtherBLUE CROSS HOME INFUSION
IL141566Medicare Oscar/Certification