Provider Demographics
NPI:1598753436
Name:UNITED METHODIST SENIOR SERVICES OF GOLDEN TRIANGLE AREA, INC.
Entity Type:Organization
Organization Name:UNITED METHODIST SENIOR SERVICES OF GOLDEN TRIANGLE AREA, INC.
Other - Org Name:TRINITY HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCALILLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-844-8977
Mailing Address - Street 1:230 AIRLINE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39702-6348
Mailing Address - Country:US
Mailing Address - Phone:662-327-9404
Mailing Address - Fax:662-328-1445
Practice Address - Street 1:230 AIRLINE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39702-6348
Practice Address - Country:US
Practice Address - Phone:662-327-9404
Practice Address - Fax:662-328-1445
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MISSISSIPPI METHODIST SENIOR SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-13
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS769314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00220326Medicaid
MS00220326Medicaid