Healthcare Provider Details

I. General information

NPI: 1033169750
Provider Name (Legal Business Name): TRINITY MISSION OF ITALY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 DAVENPORT
ITALY TX
76651-3592
US

IV. Provider business mailing address

220 DAVENPORT
ITALY TX
76651-3592
US

V. Phone/Fax

Practice location:
  • Phone: 972-483-6369
  • Fax: 972-483-6114
Mailing address:
  • Phone: 972-483-6369
  • Fax: 972-483-6114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number116239
License Number StateTX

VIII. Authorized Official

Name: DOVE1ITAL J MURPHY
Title or Position: VICE PRESIDENT
Credential:
Phone: 901-937-7994