Provider Demographics
NPI:1306147624
Name:TRINITY COMFORT CENTER, LLC
Entity type:Organization
Organization Name:TRINITY COMFORT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:RENEE'
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-381-9319
Mailing Address - Street 1:2045 MOUNT ZION RD
Mailing Address - Street 2:STE 283
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-3313
Mailing Address - Country:US
Mailing Address - Phone:770-471-9277
Mailing Address - Fax:770-234-5686
Practice Address - Street 1:11414 VINEA LN
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-6260
Practice Address - Country:US
Practice Address - Phone:770-471-9277
Practice Address - Fax:770-234-5686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACLA001049310400000X, 320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility