Provider Demographics
NPI:1780893941
Name:TRINITY LIVING CENTER
Entity type:Organization
Organization Name:TRINITY LIVING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEDIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WELTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-328-4620
Mailing Address - Street 1:21382 HWY 51
Mailing Address - Street 2:
Mailing Address - City:QULIN
Mailing Address - State:MO
Mailing Address - Zip Code:63961
Mailing Address - Country:US
Mailing Address - Phone:573-328-4620
Mailing Address - Fax:
Practice Address - Street 1:21382 HWY 51
Practice Address - Street 2:
Practice Address - City:QULIN
Practice Address - State:MO
Practice Address - Zip Code:63961
Practice Address - Country:US
Practice Address - Phone:573-328-4620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Not Answered385H00000XRespite Care FacilityRespite Care