=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306497284
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRINITY HEALTHY LIVING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2019
-----------------------------------------------------
Last Update Date | 01/27/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 58 E MAIN RD
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02842-4988
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-608-3322
-----------------------------------------------------
Fax | 401-608-3323
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 58 E MAIN RD
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02842-4988
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-608-3322
-----------------------------------------------------
Fax | 401-608-3323
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. CHRISTINE NOLAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 401-662-5390
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------