Provider Demographics
NPI:1720364938
Name:TRINITY HOME MEDICAL INC
Entity Type:Organization
Organization Name:TRINITY HOME MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NADIRAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MATOUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-534-5724
Mailing Address - Street 1:11450 TEA TREE LN
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-5102
Mailing Address - Country:US
Mailing Address - Phone:815-534-5724
Mailing Address - Fax:815-277-2456
Practice Address - Street 1:9500 W LINCOLN HWY UNIT 5
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1940
Practice Address - Country:US
Practice Address - Phone:708-341-7116
Practice Address - Fax:815-277-2456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies