Provider Demographics
NPI:1992897599
Name:TRINITY HOME CARE LLC
Entity type:Organization
Organization Name:TRINITY HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ACCOUNTS PAYABLE
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-479-0874
Mailing Address - Street 1:940 SW CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-2755
Mailing Address - Country:US
Mailing Address - Phone:541-479-0874
Mailing Address - Fax:541-476-0933
Practice Address - Street 1:940 SW CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-2755
Practice Address - Country:US
Practice Address - Phone:541-479-0874
Practice Address - Fax:541-476-0933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR152142311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility