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General NPI Number Information
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NPI Number | 1831596659
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Entity Type | Organization
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Legal Business Name | TRINITY VILLAGE, INC
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Dates
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Enumeration Date | 11/21/2014
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Last Update Date | 11/21/2014
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Provider Practice Location Address
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Address Line | 6400 TRINITY DR
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City | PINE BLUFF
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State | AR
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Zip | 71603-7802
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Country | US
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Telephone | 870-879-3113
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Fax | 870-879-2246
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Provider Business Mailing Address
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Address Line | 6400 TRINITY DR
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City | PINE BLUFF
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State | AR
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Zip | 71603-7802
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Country | US
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Telephone | 870-879-3113
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Fax | 870-879-2246
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. DONNA STONE
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Credential |
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Telephone | 870-879-3113
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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 | 089
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License Number State | AR
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