Provider Demographics
NPI:1982766556
Name:PM MANAGEMENT-TRINITY NC LLC
Entity Type:Organization
Organization Name:PM MANAGEMENT-TRINITY NC LLC
Other - Org Name:TRINITY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEW
Authorized Official - Middle Name:N
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:512-634-4900
Mailing Address - Street 1:1703 W 5TH ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4893
Mailing Address - Country:US
Mailing Address - Phone:512-634-4900
Mailing Address - Fax:512-634-4950
Practice Address - Street 1:1000 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-4442
Practice Address - Country:US
Practice Address - Phone:512-255-2521
Practice Address - Fax:512-255-1491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX127556314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004038OtherFACILITY ID NO.
TX001003966Medicaid
TX675546Medicare Oscar/Certification