Tri-Care Home Health Inc
Organization Active NPI Home Health Agency · Rolla, ND
NPI 1609887397 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1609887397
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- License
- 00000 (ND)
- Legal business name
- TRI-CARE HOME HEALTH INC
- Practice address
- 1104 Hwy 5 W
Rolla, ND 58367-0040 - Phone
- (701) 477-6232
- NPI assigned
- Aug 10, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Lori Jo Sollin, RN
- Title
- Administrator
- Phone
- (701) 477-6232
Practitioners 1
-
Tobias Tyler McCabe, D.C.
Affiliated clinicians 2
-
Tyrone Berentson, MD
Medicare Care Compare: Home health agency
- Listed as
- Tri Care Home Health, Inc.
- Ownership
- Proprietary
- Certified
- Mar 17, 1986
- Medicare certification status
- Active
- Services
- Nursing, Home health aide
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 35D0408697 | Tri Care Home Health Inc | Certificate of waiver | Jul 21, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ND
Home health agency certification: CCN 357040
- Legal name
- TRI-CARE HOME HEALTH INC
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Mar 17, 1986
- Last certification
- Jul 13, 2021
- Ownership / control type
- Proprietary
- Organization structure
- Corporation · Proprietary
- Incorporated
- Jan 1, 1986 in ND
- Enrollment address
- 1104 Main Ave W
Rolla, ND 58367-7609
All disclosed owners & managing parties 1
| Name | Role | Since | Share |
|---|---|---|---|
| Sarah Gailfus |
5% Or Greater Direct Ownership Interest | Jul 1, 2024 | 100% |
| Corporate Officer |
Jul 1, 2024 | ||
| Corporate Director |
Jul 1, 2024 | ||
| W-2 Managing Employee |
Jul 1, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100405000324 | ND | Part a Provider - Home Health Agency | 3678609344 | Practice locations: Rolla, ND |
National Provider Directory
Locations
1104 Main Ave W
Rolla, ND 58367
Phone (701) 477-6232
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 00000 | ND | Yes |
Addresses
Primary practice location
1104 Hwy 5 W
Rolla, ND 58367-0040
Mailing address
PO Box 40
1104 Hwy 5 W
Rolla, ND 58367-0040
Phone (701) 477-6232
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 55990 | Medicaid | ND |
Other providers in Rolla, ND
- Rolla Drug Inc
- Rolla Eye Clinic
- Patricia J Sitter
- Nevaeh St Germaine
- Joseph A Thorman
- Turner Dental Office PC
- William Warren Turner
- Turtle Mountain Home Healthcare LLC
- Michael Vandal
- Kayla M Wallette
All providers in Rolla, ND · Home Health Agency in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.