MEDICARE: TRINITY NATIONWIDE RECOVERY 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1891351235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY NATIONWIDE RECOVERY INC

Provider Business Mailing Address
First Line	:	12433 LAMBERT RD STE A
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90606-2779
Country	:	US
Telephone Number	:	562-383-9109
Fax Number	:	714-276-9611

Provider Business Practice Location Address
First Line	:	12433 LAMBERT RD STE A&B
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90606-2770
Country	:	US
Telephone Number	:	844-887-4648
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	EDGAR ANTONIO VILLA
Credential	:	LCSW
Telephone Number	:	714-589-9228

Provider Enumeration Date	:	05/10/2019
Last Update Date	:	01/27/2026

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