Healthcare Provider Details

I. General information

NPI: 1316553019
Provider Name (Legal Business Name): TRINITY HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 06/08/2022
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13101 PRESTON RD STE 425
DALLAS TX
75240-5278
US

IV. Provider business mailing address

13101 PRESTON RD STE 200
DALLAS TX
75240-5220
US

V. Phone/Fax

Practice location:
  • Phone: 310-619-3491
  • Fax:
Mailing address:
  • Phone: 310-619-3491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. JASON BRAZELL
Title or Position: COO
Credential:
Phone: 310-619-3491