Provider Demographics
NPI:1831596659
Name:TRINITY VILLAGE, INC
Entity type:Organization
Organization Name:TRINITY VILLAGE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-879-3113
Mailing Address - Street 1:6400 TRINITY DR
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-7802
Mailing Address - Country:US
Mailing Address - Phone:870-879-3113
Mailing Address - Fax:870-879-2246
Practice Address - Street 1:6400 TRINITY DR
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-7802
Practice Address - Country:US
Practice Address - Phone:870-879-3113
Practice Address - Fax:870-879-2246
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY VILLAGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR089310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR202271794Medicaid