Provider Demographics
NPI:1215016340
Name:TRINITY CONITUNING CARE SERVICES
Entity Type:Organization
Organization Name:TRINITY CONITUNING CARE SERVICES
Other - Org Name:ABBEY LIVING CTR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-305-7688
Mailing Address - Street 1:PO BOX 9184
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48333-9184
Mailing Address - Country:US
Mailing Address - Phone:248-305-7919
Mailing Address - Fax:248-305-7677
Practice Address - Street 1:12250 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3516
Practice Address - Country:US
Practice Address - Phone:586-751-6200
Practice Address - Fax:586-751-2234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI504010314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23-5509Medicare Oscar/Certification