Provider Demographics
NPI:1962606848
Name:TRINITY CENTRAL HOME HEALTH, LLC
Entity type:Organization
Organization Name:TRINITY CENTRAL HOME HEALTH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-783-4672
Mailing Address - Street 1:415 ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-1903
Mailing Address - Country:US
Mailing Address - Phone:479-783-4672
Mailing Address - Fax:479-783-2217
Practice Address - Street 1:835 CENTRAL AVE STE 511
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-5310
Practice Address - Country:US
Practice Address - Phone:501-321-0708
Practice Address - Fax:501-321-9567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4312251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR186061514Medicaid
AR186061514Medicaid
047147Medicare Oscar/Certification