Provider Demographics
NPI:1770933343
Name:TRINITY HOME CARE SERVICES LLC
Entity type:Organization
Organization Name:TRINITY HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHIKATA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHYNE-SAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:571-398-6736
Mailing Address - Street 1:3102 GOLANSKY BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4244
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3102 GOLANSKY BLVD STE 201
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4244
Practice Address - Country:US
Practice Address - Phone:571-398-6736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-15
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1770933343Medicaid