Healthcare Provider Details

I. General information

NPI: 1558405993
Provider Name (Legal Business Name): TRINITY VILLAGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 TRINITY DR
PINE BLUFF AR
71603-7802
US

IV. Provider business mailing address

6400 TRINITY DR
PINE BLUFF AR
71603-7802
US

V. Phone/Fax

Practice location:
  • Phone: 870-879-3117
  • Fax: 870-879-6422
Mailing address:
  • Phone: 870-879-3117
  • Fax: 870-879-6422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number314
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTINA JOANNA SMITH
Title or Position: ADMINISTRATOR
Credential:
Phone: 870-879-3117