Provider Demographics
NPI:1720593163
Name:TRINITY CONTINUING CARE SERVICE
Entity Type:Organization
Organization Name:TRINITY CONTINUING CARE SERVICE
Other - Org Name:BEAVEN KELLY HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KASTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-343-6644
Mailing Address - Street 1:17410 COLLEGE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-2369
Mailing Address - Country:US
Mailing Address - Phone:734-343-6628
Mailing Address - Fax:734-343-6461
Practice Address - Street 1:25 BRIGHTSIDE DR
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-4033
Practice Address - Country:US
Practice Address - Phone:413-539-2618
Practice Address - Fax:413-539-2859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-07
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home