Provider Demographics
NPI:1154878106
Name:TRINA HEALTH OF BOONEVILLE, INC.
Entity type:Organization
Organization Name:TRINA HEALTH OF BOONEVILLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLEVELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-554-9252
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829-0367
Mailing Address - Country:US
Mailing Address - Phone:662-554-9252
Mailing Address - Fax:662-728-5185
Practice Address - Street 1:202 N 1ST ST STE B
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829-2718
Practice Address - Country:US
Practice Address - Phone:662-554-9252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS480712Medicare PIN