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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1497341168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY INTEGRATED CARE

Provider Business Mailing Address
First Line	:	4637 S 7TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85040-2219
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4637 S 7TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85040-2219
Country	:	US
Telephone Number	:	602-456-0769
Fax Number	:

Authorized Official
Title or Position	:	PRIMARY CONTACT
Name	:	LIZ GRANT
Credential	:
Telephone Number	:	602-456-0769

Provider Enumeration Date	:	12/17/2020
Last Update Date	:	12/17/2020

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Directions to “TRINITY INTEGRATED CARE ” Practice Location

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