=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497819668
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRINITY III INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 214 NORTH MORGAN STREET
-----------------------------------------------------
City | SHELBY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-482-0901
-----------------------------------------------------
Fax | 704-482-2081
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 214 N MORGAN ST
-----------------------------------------------------
City | SHELBY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28150-4431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-482-0901
-----------------------------------------------------
Fax | 704-482-2081
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. GWENDOLYN FOX
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 704-482-0901
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number | MHL-023-043
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number | MHL-023-097
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number | MHL-023-088
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------