Provider Demographics
NPI:1003913773
Name:TRINITY HAVEN HEALTHCARE CENTER, INC.
Entity Type:Organization
Organization Name:TRINITY HAVEN HEALTHCARE CENTER, INC.
Other - Org Name:TRINITY HAVEN OF MIDLAND
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MONCRIEF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-683-5403
Mailing Address - Street 1:3203 SAGE ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-5711
Mailing Address - Country:US
Mailing Address - Phone:432-683-5403
Mailing Address - Fax:432-682-5105
Practice Address - Street 1:3203 SAGE ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-5711
Practice Address - Country:US
Practice Address - Phone:432-683-5403
Practice Address - Fax:432-682-5105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX004280314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility