Provider Demographics
NPI:1427644475
Name:TRINITY INTEGRATED CARE
Entity type:Organization
Organization Name:TRINITY INTEGRATED CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:AGBOOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-589-6692
Mailing Address - Street 1:8767 E VIA DE VENTURA STE 170
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3380
Mailing Address - Country:US
Mailing Address - Phone:480-589-6692
Mailing Address - Fax:
Practice Address - Street 1:4635 S 7TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-2219
Practice Address - Country:US
Practice Address - Phone:602-388-4795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-14
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness