Healthcare Provider Details

I. General information

NPI: 1982245312
Provider Name (Legal Business Name): TRINITY SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 E MAIN ST
MASCOUTAH IL
62258-2240
US

IV. Provider business mailing address

301 VETERANS PKWY
NEW LENOX IL
60451-2899
US

V. Phone/Fax

Practice location:
  • Phone: 618-566-0313
  • Fax:
Mailing address:
  • Phone: 815-485-6197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: BOB TAYLOR
Title or Position: CFO
Credential:
Phone: 815-320-7190