=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902964307
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRINITY HILL CARE CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2006
-----------------------------------------------------
Last Update Date | 05/31/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 151 HILLSIDE AVE
-----------------------------------------------------
City | HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06106-3527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-951-1060
-----------------------------------------------------
Fax | 860-951-3459
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 151 HILLSIDE AVE
-----------------------------------------------------
City | HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06106-3527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-951-1060
-----------------------------------------------------
Fax | 860-951-3459
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MR. CHRISTOPHER S WRIGHT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 860-570-2140
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 2222-C
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------