Provider Demographics
NPI:1952353914
Name:TRINITY MISSION HEALTH & REHAB OF EDGEFIELD, LP
Entity Type:Organization
Organization Name:TRINITY MISSION HEALTH & REHAB OF EDGEFIELD, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ULLERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-937-7994
Mailing Address - Street 1:226 W. A. REEL DRIVE
Mailing Address - Street 2:
Mailing Address - City:EDGEFIELD
Mailing Address - State:SC
Mailing Address - Zip Code:29824
Mailing Address - Country:US
Mailing Address - Phone:803-637-5312
Mailing Address - Fax:803-637-0059
Practice Address - Street 1:226 WA REEL DR
Practice Address - Street 2:
Practice Address - City:EDGEFIELD
Practice Address - State:SC
Practice Address - Zip Code:29824-4534
Practice Address - Country:US
Practice Address - Phone:803-637-5312
Practice Address - Fax:803-637-0059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCNCF-591314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0591NHMedicaid
SC42-5293Medicare ID - Type Unspecified