Provider Demographics
NPI:1700821493
Name:TRINITY WOODS
Entity Type:Organization
Organization Name:TRINITY WOODS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:WILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-346-6625
Mailing Address - Street 1:4134 E 31ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-1511
Mailing Address - Country:US
Mailing Address - Phone:918-743-2565
Mailing Address - Fax:918-743-1174
Practice Address - Street 1:4134 E 31ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-1511
Practice Address - Country:US
Practice Address - Phone:918-743-2565
Practice Address - Fax:918-743-1174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKAL7226-7226310400000X
OKNH7218-7218311500000X, 313M00000X, 314000000X
OKNH72187218314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100772940AMedicaid
OK100772940AMedicaid