Healthcare Provider Details

I. General information

NPI: 1932236767
Provider Name (Legal Business Name): TRINITY VILLAGE,INC. DOING BUSINESS AS TRINITY VILLAGE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/22/2020
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: 870-879-3113
  • Fax: 870-879-2246
Mailing address:
  • Phone: 870-879-3113
  • Fax: 870-879-2246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JAMES ROBERT NEFF
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 870-879-3113