MEDICARE: TRINITY HEALTH CARE SERVICES OF MINGO INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	313M00000X	Nursing Facility/Intermediate Care Facility	92	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194800847
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY HEALTH CARE SERVICES OF MINGO INC

Provider Business Mailing Address
First Line	:	2115 REXFORD RD STE 100
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-3476
Country	:	US
Telephone Number	:	704-369-7200
Fax Number	:	704-362-0411

Provider Business Practice Location Address
First Line	:	100 HILLCREST DR
Second Line	:
City	:	WILLIAMSON
State	:	WV
Zip	:	25661-3948
Country	:	US
Telephone Number	:	304-235-2005
Fax Number	:	304-752-8723

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RONALD G VANCE
Credential	:	CPA
Telephone Number	:	704-369-7200

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	04/09/2013

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