MEDICARE: TRINITY TRANSITIONAL 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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility

General Provider Information

NPI Number	:	1740598127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY TRANSITIONAL CARE

Provider Business Mailing Address
First Line	:	PO BOX 50322
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76105-0322
Country	:	US
Telephone Number	:	864-266-7845
Fax Number	:

Provider Business Practice Location Address
First Line	:	3509 RICHARDSON CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76119-1713
Country	:	US
Telephone Number	:	864-266-7845
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	MS. LATOYA JANET MCKINNEY
Credential	:
Telephone Number	:	864-266-7845

Provider Enumeration Date	:	09/19/2010
Last Update Date	:	09/19/2010

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