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General NPI Number Information
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NPI Number | 1306147624
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Entity Type | Organization
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Legal Business Name | TRINITY COMFORT CENTER, LLC
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Dates
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Enumeration Date | 11/03/2010
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Last Update Date | 11/03/2010
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Provider Practice Location Address
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Address Line | 11414 VINEA LN
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City | HAMPTON
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State | GA
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Zip | 30228-6260
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Country | US
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Telephone | 770-471-9277
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Fax | 770-234-5686
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Provider Business Mailing Address
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Address Line | 2045 MOUNT ZION RD STE 283
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City | MORROW
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State | GA
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Zip | 30260-3313
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Country | US
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Telephone | 770-471-9277
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Fax | 770-234-5686
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Authorized Official
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Title or Position | CEO
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Name | MS. ELIZABETH RENEE' CLARK
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Credential |
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Telephone | 205-381-9319
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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 | CLA001049
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | CLA001049
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License Number State | GA
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