Provider Demographics
NPI:1205374949
Name:TRINITY 30/60/100
Entity Type:Organization
Organization Name:TRINITY 30/60/100
Other - Org Name:LIVING WELL ADULT LIVING FACILITY AFC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARVA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:TOWNSEND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-633-8284
Mailing Address - Street 1:1001 LAFAYETTE AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-1106
Mailing Address - Country:US
Mailing Address - Phone:616-649-0104
Mailing Address - Fax:616-649-0126
Practice Address - Street 1:1001 LAFAYETTE AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-1106
Practice Address - Country:US
Practice Address - Phone:616-649-0104
Practice Address - Fax:616-649-0126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty