Provider Demographics
NPI:1962492777
Name:TRINITY R&R I LP
Entity type:Organization
Organization Name:TRINITY R&R I LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:C F O
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-303-4089
Mailing Address - Street 1:902 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAN AUGUSTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75972-2316
Mailing Address - Country:US
Mailing Address - Phone:936-275-2055
Mailing Address - Fax:936-275-5658
Practice Address - Street 1:902 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SAN AUGUSTINE
Practice Address - State:TX
Practice Address - Zip Code:75972-2316
Practice Address - Country:US
Practice Address - Phone:936-275-2055
Practice Address - Fax:936-275-5658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113720314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675846Medicare Oscar/Certification