Provider Demographics
NPI:1184719312
Name:TRINITAS REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:TRINITAS REGIONAL MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-994-5000
Mailing Address - Street 1:225 WILLIAMSON STREET
Mailing Address - Street 2:PHYSICIAN BILLING
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07207
Mailing Address - Country:US
Mailing Address - Phone:908-994-8068
Mailing Address - Fax:908-994-8090
Practice Address - Street 1:655 E. JERSEY STREET
Practice Address - Street 2:RESIDENTIAL SERVICES
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07206
Practice Address - Country:US
Practice Address - Phone:908-994-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITAS REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-04
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ12007282N00000X, 323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0096130Medicaid
NJ0323837Medicaid