MEDICARE: TRINITY INTEGRATED CARE

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	3104A0625X	Assisted Living Facility (Mental Illness)
2	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1427644475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY INTEGRATED CARE

Provider Business Mailing Address
First Line	:	8767 E VIA DE VENTURA STE 170
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-3380
Country	:	US
Telephone Number	:	480-589-6692
Fax Number	:

Provider Business Practice Location Address
First Line	:	4635 S 7TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85040-2219
Country	:	US
Telephone Number	:	602-388-4795
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	STEVE AGBOOLA
Credential	:
Telephone Number	:	480-589-6692

Provider Enumeration Date	:	12/14/2020
Last Update Date	:	03/05/2024

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Directions to “TRINITY INTEGRATED CARE ” Practice Location

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