Provider Demographics
NPI:1356667232
Name:TRINITY REHABBILITATION INC
Entity Type:Organization
Organization Name:TRINITY REHABBILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER OWNER DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:NESS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:479-751-7122
Mailing Address - Street 1:1350 S GUTENSOHN RD
Mailing Address - Street 2:STE 10
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-5117
Mailing Address - Country:US
Mailing Address - Phone:479-751-7122
Mailing Address - Fax:479-751-7292
Practice Address - Street 1:1350 S GUTENSOHN RD
Practice Address - Street 2:STE 10
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-5117
Practice Address - Country:US
Practice Address - Phone:479-751-7122
Practice Address - Fax:479-751-7292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR129520741Medicaid
AR5C037OtherBLUE CROSS BLUE SHIELD
AR046548Medicare UPIN
4952910001Medicare NSC