Basic Information
| Provider Information | |||||||||
| NPI: | 1962492777 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TRINITY R&R I LP | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TRINITY REHABILITATION AND RETIREMENT COMMUNITY OF SAN AUGUSTINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 902 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SAN AUGUSTINE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 759722316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9362752055 | ||||||||
| FaxNumber: | 9362755658 | ||||||||
| Practice Location | |||||||||
| Address1: | 902 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SAN AUGUSTINE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 759722316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9362752055 | ||||||||
| FaxNumber: | 9362755658 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2005 | ||||||||
| LastUpdateDate: | 04/27/2009 | ||||||||
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| AuthorizedOfficialLastName: | CONLEY | ||||||||
| AuthorizedOfficialFirstName: | SHAWN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | C F O | ||||||||
| AuthorizedOfficialTelephone: | 8173034089 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 113720 | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.