Provider Demographics
NPI:1588900310
Name:TRINITY CARE SERVICES
Entity type:Organization
Organization Name:TRINITY CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-275-2639
Mailing Address - Street 1:1603 CAPITOL AVE
Mailing Address - Street 2:SUITE 510
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4569
Mailing Address - Country:US
Mailing Address - Phone:307-275-2639
Mailing Address - Fax:
Practice Address - Street 1:1603 CAPITOL AVE
Practice Address - Street 2:SUITE 510
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4569
Practice Address - Country:US
Practice Address - Phone:307-635-2888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY132080700320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY132080700Medicaid