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General NPI Number Information
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NPI Number | 1790975357
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Entity Type | Organization
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Legal Business Name | TRINITY ICF/MR, INC.
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 07/30/2007
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Provider Practice Location Address
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Address Line | 2813 COUNTRY VALLEY RD
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City | GARLAND
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State | TX
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Zip | 75043-1121
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Country | US
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Telephone | 972-202-9700
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Fax | 972-202-9703
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Provider Business Mailing Address
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Address Line | 2813 COUNTRY VALLEY RD
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City | GARLAND
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State | TX
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Zip | 75043-1121
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Country | US
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Telephone | 972-202-9700
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Fax | 972-202-9703
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Authorized Official
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Title or Position | VICE PRES.
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Name | MR. ALTON G. SPEARS
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Credential |
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Telephone | 972-202-9700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 007404
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License Number State | TX
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