Provider Demographics
NPI:1497080279
Name:TRINITY MANOR ASSISTED LIVING HOME
Entity Type:Organization
Organization Name:TRINITY MANOR ASSISTED LIVING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SURRATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-866-9415
Mailing Address - Street 1:705 S WELDON ST
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-3967
Mailing Address - Country:US
Mailing Address - Phone:704-866-9415
Mailing Address - Fax:704-866-9416
Practice Address - Street 1:705 S WELDON ST
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-3967
Practice Address - Country:US
Practice Address - Phone:704-866-9415
Practice Address - Fax:704-866-9416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-12
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-036-028310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility