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General NPI Number Information
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NPI Number | 1033580808
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Entity Type | Organization
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Legal Business Name | TRINITY LIFE GARDENS
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Dates
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Enumeration Date | 10/19/2015
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Last Update Date | 10/19/2015
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Provider Practice Location Address
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Address Line | 2430 OAKSHIRE LN
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City | PUEBLO
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State | CO
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Zip | 81001-5655
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Country | US
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Telephone | 719-542-2223
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Fax | 719-586-9256
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Provider Business Mailing Address
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Address Line | 2430 OAKSHIRE LN
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City | PUEBLO
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State | CO
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Zip | 81001-5655
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Country | US
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Telephone | 719-542-2223
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Fax | 719-586-9256
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. KRISS PRADO
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Credential | RN
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Telephone | 719-406-5288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 2306B3
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License Number State | CO
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