Healthcare Provider Details

I. General information

NPI: 1306497284
Provider Name (Legal Business Name): TRINITY HEALTHY LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 01/27/2022
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 E MAIN RD
MIDDLETOWN RI
02842-4988
US

IV. Provider business mailing address

58 E MAIN RD
MIDDLETOWN RI
02842-4988
US

V. Phone/Fax

Practice location:
  • Phone: 401-608-3322
  • Fax: 401-608-3323
Mailing address:
  • Phone: 401-608-3322
  • Fax: 401-608-3323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHRISTINE NOLAN
Title or Position: CEO
Credential:
Phone: 401-662-5390