Basic Information
| Provider Information | |||||||||
| NPI: | 1174510952 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRINITY CONTINUING CARE SERVICES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THE ALVERNO | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17410 COLLEGE PKWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481522369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7345428300 | ||||||||
| FaxNumber: | 7345428383 | ||||||||
| Practice Location | |||||||||
| Address1: | 849 13TH AVE N | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | IA | ||||||||
| PostalCode: | 527325168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5632421521 | ||||||||
| FaxNumber: | 5632433016 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2005 | ||||||||
| LastUpdateDate: | 09/12/2013 | ||||||||
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| AuthorizedOfficialLastName: | GOSIK | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7345428366 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | N-192 | IA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 0800086 | 05 | IA | MEDICAID |