Trinity Care Home of Marietta, LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

033013151 Issued in GA

Legal business name

TRINITY CARE HOME OF MARIETTA, LLC

Practice address

4150 Lower Roswell Rd
Marietta, GA 30068-4065

Phone

(770) 675-3117

NPI assigned

Mar 1, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Bertony Bornelus, BSW

Title

Adminstrator

Phone

(850) 766-5208

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1298937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298937600000",
    "number": "1215235296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4150 LOWER ROSWELL RD",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300684065",
            "telephone_number": "770-675-3117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4150 LOWER ROSWELL RD",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300684065",
            "telephone_number": "770-675-3117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRINITY CARE HOME OF MARIETTA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-01",
        "last_updated": "2011-03-01",
        "status": "A",
        "authorized_official_last_name": "BORNELUS",
        "authorized_official_first_name": "BERTONY",
        "authorized_official_title_or_position": "ADMINSTRATOR",
        "authorized_official_telephone_number": "850-766-5208",
        "authorized_official_credential": "BSW"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "GA",
            "license": "033013151",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Care Home Facility in Marietta, GA
• Providers in Marietta, GA by specialty
• Adult Care Home Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.