Basic Information
| Provider Information | |||||||||
| NPI: | 1265483051 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRINITY MISSION NEW PARIS RESIDENTIAL CARE FACILITY, LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7739 US HIGHWAY 40 | ||||||||
| Address2: | |||||||||
| City: | NEW PARIS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453479048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374372311 | ||||||||
| FaxNumber: | 9374373508 | ||||||||
| Practice Location | |||||||||
| Address1: | 7739 US HIGHWAY 40 | ||||||||
| Address2: | |||||||||
| City: | NEW PARIS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453479048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374372311 | ||||||||
| FaxNumber: | 9374373508 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ESTES | ||||||||
| AuthorizedOfficialFirstName: | DAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9019377994 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 315P00000X | 1035N | OH | Y | Nursing & Custodial Care Facilities | Intermediate Care Facility, Mentally Retarded |
ID Information
| ID | Type | State | Issuer | Description | 1404555 | 05 | OH | MEDICAID |