Provider Demographics
NPI:1932236767
Name:TRINITY VILLAGE,INC. DOING BUSINESS AS TRINITY VILLAGE MEDICAL CENTER
Entity type:Organization
Organization Name:TRINITY VILLAGE,INC. DOING BUSINESS AS TRINITY VILLAGE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:NEFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-879-3113
Mailing Address - Street 1:6400 TRINITY DR
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-7802
Mailing Address - Country:US
Mailing Address - Phone:870-879-3113
Mailing Address - Fax:870-879-2246
Practice Address - Street 1:6400 TRINITY DR
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-7802
Practice Address - Country:US
Practice Address - Phone:870-879-3113
Practice Address - Fax:870-879-2246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR314314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility