Provider Demographics
NPI:1164472809
Name:TRINITY MISSION OF WINNSBORO, LLC
Entity Type:Organization
Organization Name:TRINITY MISSION OF WINNSBORO, LLC
Other - Org Name:TRINITY MISSION HEALTH & REHAB OF WINNSBORO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-937-7994
Mailing Address - Street 1:502 E COKE RD
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:75494-3416
Mailing Address - Country:US
Mailing Address - Phone:903-342-6951
Mailing Address - Fax:903-342-3387
Practice Address - Street 1:502 E COKE RD
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:TX
Practice Address - Zip Code:75494-3416
Practice Address - Country:US
Practice Address - Phone:903-342-6951
Practice Address - Fax:903-342-3387
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COVENANT DOVE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-11
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116240314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001001885Medicaid
675051Medicare Oscar/Certification