Provider Demographics
NPI:1932293073
Name:TRINITY CONTINUING CARE SERVICES
Entity Type:Organization
Organization Name:TRINITY CONTINUING CARE SERVICES
Other - Org Name:SANCTUARY AT THE PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-542-8348
Mailing Address - Street 1:PO BOX 9184
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48333-9184
Mailing Address - Country:US
Mailing Address - Phone:734-542-8300
Mailing Address - Fax:734-542-8384
Practice Address - Street 1:570 HARVEY ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-2308
Practice Address - Country:US
Practice Address - Phone:231-773-9121
Practice Address - Fax:231-777-3983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI614110314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI60-2623876Medicaid
MI09966OtherBCBSM
MI60-2623876Medicaid