Healthcare Provider Details

I. General information

NPI: 1801982830
Provider Name (Legal Business Name): TRINITY SIERRA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14318 OHIO ST
BALDWIN PARK CA
91706-2553
US

IV. Provider business mailing address

14318 OHIO ST
BALDWIN PARK CA
91706-2553
US

V. Phone/Fax

Practice location:
  • Phone: 626-960-1971
  • Fax: 626-960-0908
Mailing address:
  • Phone: 626-960-1971
  • Fax: 626-960-0908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierLTC06466H
Identifier TypeMEDICAID
Identifier StateCA
Identifier Issuer

VIII. Authorized Official

Name: RANDAL KLEIS
Title or Position: PRESIDENT
Credential:
Phone: 425-820-9750