Provider Demographics
NPI:1730139460
Name:TRINITY MISSION OF SHENANDOAH HEIGHTS, LLC
Entity Type:Organization
Organization Name:TRINITY MISSION OF SHENANDOAH HEIGHTS, LLC
Other - Org Name:TRINITY MISSION HEALTH & REHAB OF SHENANDOAH HEIGHTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PINTILIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-937-7994
Mailing Address - Street 1:200 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:PA
Mailing Address - Zip Code:17976-1332
Mailing Address - Country:US
Mailing Address - Phone:570-462-1921
Mailing Address - Fax:571-462-4946
Practice Address - Street 1:200 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:PA
Practice Address - Zip Code:17976-1332
Practice Address - Country:US
Practice Address - Phone:570-462-1921
Practice Address - Fax:571-462-4946
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COVENANT DOVE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-11
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA152502314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1886166Medicaid
PA1886166Medicaid