Provider Demographics
NPI:1538815899
Name:TRINITY RESIDENTIAL CARE LLC
Entity type:Organization
Organization Name:TRINITY RESIDENTIAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KABANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-332-7144
Mailing Address - Street 1:12 RED OAK DR STE 2C
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2099
Mailing Address - Country:US
Mailing Address - Phone:207-332-7144
Mailing Address - Fax:
Practice Address - Street 1:12 RED OAK DR STE 2C
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2099
Practice Address - Country:US
Practice Address - Phone:207-332-7144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities