Provider Demographics
NPI:1700800455
Name:TRINITY VISITING NURSE AND HOMECARE ASSOCIATION
Entity Type:Organization
Organization Name:TRINITY VISITING NURSE AND HOMECARE ASSOCIATION
Other - Org Name:TRINITY PATHWAY HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:J
Authorized Official - Last Name:RICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:309-779-7242
Mailing Address - Street 1:106 19 AVENUE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265
Mailing Address - Country:US
Mailing Address - Phone:309-779-7600
Mailing Address - Fax:309-779-7252
Practice Address - Street 1:4500 UTICA RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722
Practice Address - Country:US
Practice Address - Phone:563-742-4700
Practice Address - Fax:563-742-4705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0610204Medicaid
IA161573Medicare ID - Type Unspecified