1588314801 NPI number — A TRINITY RESIDENTIAL CARE HCS LLC

Table of content: (NPI 1588314801)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588314801 NPI number — A TRINITY RESIDENTIAL CARE HCS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A TRINITY RESIDENTIAL CARE HCS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588314801
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 COLD WATER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DESOTO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75115-3795
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-217-0598
Provider Business Mailing Address Fax Number:
214-242-4598

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6919 ORIOLE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75209-4810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-217-0598
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2022

Additional Information

Authorized Official

Authorized Official Last Name:
TURNER
Authorized Official First Name:
MARK
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
972-217-0598

Provider Taxonomy Codes

  • Taxonomy code: 3104A0630X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 311ZA0620X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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