Provider Demographics
NPI:1740279868
Name:TRINITY HOME CARE SERIVCES, INC.
Entity type:Organization
Organization Name:TRINITY HOME CARE SERIVCES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:LEOLA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:405-341-4361
Mailing Address - Street 1:301 S BRYANT AVE
Mailing Address - Street 2:SUITE A700
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-5790
Mailing Address - Country:US
Mailing Address - Phone:405-341-4361
Mailing Address - Fax:405-341-4349
Practice Address - Street 1:301 S BRYANT AVE
Practice Address - Street 2:SUITE A700
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5790
Practice Address - Country:US
Practice Address - Phone:405-341-4361
Practice Address - Fax:405-341-4349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7760251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200058280Medicaid
OK377666Medicare ID - Type Unspecified