Healthcare Provider Details

I. General information

NPI: 1215016340
Provider Name (Legal Business Name): TRINITY CONITUNING CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12250 E 12 MILE RD
WARREN MI
48093-3516
US

IV. Provider business mailing address

PO BOX 9184
FARMINGTON HILLS MI
48333-9184
US

V. Phone/Fax

Practice location:
  • Phone: 586-751-6200
  • Fax: 586-751-2234
Mailing address:
  • Phone: 248-305-7919
  • Fax: 248-305-7677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number504010
License Number StateMI

VIII. Authorized Official

Name: JACKIE HARRIS
Title or Position: CEO
Credential:
Phone: 248-305-7688