Provider Demographics
NPI:1780943910
Name:FIRST TRINITY HOMECARESERVICES INC.
Entity type:Organization
Organization Name:FIRST TRINITY HOMECARESERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EMEKA
Authorized Official - Middle Name:JUSTIN
Authorized Official - Last Name:OTIWU
Authorized Official - Suffix:
Authorized Official - Credentials:BBA
Authorized Official - Phone:770-355-4114
Mailing Address - Street 1:3965 BRADFORD WALK TRL
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-7840
Mailing Address - Country:US
Mailing Address - Phone:770-831-0013
Mailing Address - Fax:770-831-0122
Practice Address - Street 1:3965 BRADFORD WALK TRL
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-7840
Practice Address - Country:US
Practice Address - Phone:770-831-0013
Practice Address - Fax:770-831-0122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067R0704251E00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health