Provider Demographics
NPI:1851425409
Name:TRINITYCARE LLC
Entity type:Organization
Organization Name:TRINITYCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DPCS
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, PHN
Authorized Official - Phone:323-981-4488
Mailing Address - Street 1:1000 CORPORATE CENTER DRIVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-9906
Mailing Address - Country:US
Mailing Address - Phone:323-981-4488
Mailing Address - Fax:323-981-4499
Practice Address - Street 1:1000 CORPORATE CENTER DRIVE
Practice Address - Street 2:SUITE 110
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-9906
Practice Address - Country:US
Practice Address - Phone:323-981-4488
Practice Address - Fax:323-981-4499
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITYCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-15
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980000632251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA07656HMedicaid
H67070OtherHARBOR REG - CERRITOS LOC
CAZZT07129HMedicaid
H17944OtherHARBOR REG - NRIDGE LOC
=========OtherEMPLOYER TAX ID
H67070OtherHARBOR REG - CERRITOS LOC
CA057656Medicare Oscar/Certification