Provider Demographics
NPI:1700843562
Name:TRINITY MISSION HEALTH & REHAB OF CONNERSVILLE, LP
Entity Type:Organization
Organization Name:TRINITY MISSION HEALTH & REHAB OF CONNERSVILLE, LP
Other - Org Name:CAROLETON MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ULLERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-937-7994
Mailing Address - Street 1:2500 IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:CONNERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47331-2404
Mailing Address - Country:US
Mailing Address - Phone:765-825-7514
Mailing Address - Fax:765-827-0116
Practice Address - Street 1:2500 IOWA AVE
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-2404
Practice Address - Country:US
Practice Address - Phone:765-825-7514
Practice Address - Fax:765-827-0116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN155387Medicare ID - Type Unspecified