Provider Demographics
NPI:1760475289
Name:TRINITY LIVING CENTER, LP
Entity Type:Organization
Organization Name:TRINITY LIVING CENTER, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:TACK
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:724-431-0770
Mailing Address - Street 1:400 HILLCREST AVE
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-1708
Mailing Address - Country:US
Mailing Address - Phone:724-431-0770
Mailing Address - Fax:724-431-0764
Practice Address - Street 1:400 HILLCREST AVE
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-1708
Practice Address - Country:US
Practice Address - Phone:724-431-0770
Practice Address - Fax:724-431-0764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA330102314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
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MA4458820001OtherNHIC, CORP
1375OtherHIGHMARK BC
320495OtherUPMC
PA4809046OtherCIGNA
PA0018464740001Medicaid
PA119691OtherUNISON
PA4809046OtherCIGNA