Provider Demographics
NPI:1497019749
Name:TRINITY MANOR OPCO LLC
Entity Type:Organization
Organization Name:TRINITY MANOR OPCO LLC
Other - Org Name:TRINITY MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOSTROH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-952-9216
Mailing Address - Street 1:PO BOX 195
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80502-0195
Mailing Address - Country:US
Mailing Address - Phone:303-952-9216
Mailing Address - Fax:303-675-5659
Practice Address - Street 1:510 W FRONTVIEW ST
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2213
Practice Address - Country:US
Practice Address - Phone:620-227-8551
Practice Address - Fax:620-225-8630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-02
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS175377Medicare Oscar/Certification