Healthcare Provider Details

I. General information

NPI: 1205374949
Provider Name (Legal Business Name): TRINITY 30/60/100
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 LAFAYETTE AVE SE
GRAND RAPIDS MI
49507-1106
US

IV. Provider business mailing address

1001 LAFAYETTE AVE SE
GRAND RAPIDS MI
49507-1106
US

V. Phone/Fax

Practice location:
  • Phone: 616-649-0104
  • Fax: 616-649-0126
Mailing address:
  • Phone: 616-649-0104
  • Fax: 616-649-0126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: MARVA LYNN TOWNSEND
Title or Position: ADMINISTRATOR
Credential:
Phone: 616-633-8284