=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568416782
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRINITY ARMS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4433 GODWIN BLVD SUITE E
-----------------------------------------------------
City | SUFFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23434-6927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-255-2050
-----------------------------------------------------
Fax | 757-255-2052
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4433 GODWIN BLVD SUITE E
-----------------------------------------------------
City | SUFFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23434-6927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-255-2050
-----------------------------------------------------
Fax | 757-255-2052
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | MRS. SHONDA DENECE WASHINGTON
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 866-370-2050
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HCO-350
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------