Provider Demographics
NPI:1326899444
Name:TRINITY RECOVERY HOME LLC
Entity Type:Organization
Organization Name:TRINITY RECOVERY HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SYDNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-387-6800
Mailing Address - Street 1:4374 N 153RD DR
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-8392
Mailing Address - Country:US
Mailing Address - Phone:602-837-6800
Mailing Address - Fax:602-837-6868
Practice Address - Street 1:17622 W PORT ROYALE LN
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388-7792
Practice Address - Country:US
Practice Address - Phone:602-837-6800
Practice Address - Fax:602-837-6868
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY RECOVERY HOME LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness