Provider Demographics
NPI:1700498375
Name:TRINITY GUARDIANS HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:TRINITY GUARDIANS HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGE
Authorized Official - Prefix:MISS
Authorized Official - First Name:MABEL
Authorized Official - Middle Name:NGANU
Authorized Official - Last Name:TIH
Authorized Official - Suffix:
Authorized Official - Credentials:LNA
Authorized Official - Phone:310-686-3936
Mailing Address - Street 1:11120 W VAN BUREN ST APT 2153
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-7272
Mailing Address - Country:US
Mailing Address - Phone:310-686-3936
Mailing Address - Fax:
Practice Address - Street 1:11120 W. VAN BUREN ST #2153
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-8532
Practice Address - Country:US
Practice Address - Phone:310-686-3936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health