Healthcare Provider Details

I. General information

NPI: 1871894568
Provider Name (Legal Business Name): TRINITY CONNECTIONS CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2010
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

659 WILMONT DR
JONESBORO GA
30238-4834
US

IV. Provider business mailing address

PO BOX 2955
STOCKBRIDGE GA
30281-8938
US

V. Phone/Fax

Practice location:
  • Phone: 678-887-6644
  • Fax: 678-284-1699
Mailing address:
  • Phone: 678-887-6644
  • Fax: 678-284-1699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number031012988
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number031012988
License Number StateGA

VIII. Authorized Official

Name: MR. HAYWARD WHITE JR.
Title or Position: CEO
Credential:
Phone: 678-887-6644