Healthcare Provider Details

I. General information

NPI: 1306979083
Provider Name (Legal Business Name): TRINITY GROUP HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17022 W RIMROCK ST
SURPRISE AZ
85388-1533
US

IV. Provider business mailing address

17022 W RIMROCK ST
SURPRISE AZ
85388-1533
US

V. Phone/Fax

Practice location:
  • Phone: 602-367-4433
  • Fax:
Mailing address:
  • Phone: 602-367-4433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CELESTE WILLIAMS
Title or Position: PROGRAM MANAGER
Credential:
Phone: 602-367-4433