Trinity Mission Wide Horizons Residential Care Facility, LP

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

UTAH #2007-NCF-104 Issued in UT

Legal business name

TRINITY MISSION WIDE HORIZONS RESIDENTIAL CARE FACILITY, LP

Practice address

910 Monroe Blvd
Ogden, UT 84404-6434

Phone

(801) 399-5876

Fax

(801) 392-2955

NPI assigned

May 16, 2006

Organization subpart

Yes

Parent organization

COVENANT DOVE, LLCAs reported in NPPES

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

Authorized official

Name

Mr. Judy Ullery

Title

President

Phone

(901) 937-7994

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207785600000",
    "number": "1841241445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 MONROE BLVD",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844046434",
            "telephone_number": "801-399-5876",
            "fax_number": "801-392-2955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 MONROE BLVD",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844046434",
            "telephone_number": "801-399-5876",
            "fax_number": "801-392-2955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRINITY MISSION WIDE HORIZONS RESIDENTIAL CARE FACILITY, LP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COVENANT DOVE, LLC",
        "enumeration_date": "2006-05-16",
        "last_updated": "2008-04-10",
        "status": "A",
        "authorized_official_last_name": "ULLERY",
        "authorized_official_first_name": "JUDY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "901-937-7994",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "UT",
            "license": "UTAH #2007-NCF-104",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "930947340014",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joel Trevino, PTA
• Tri-County Independent Living Center
• Tri-County Independent Living Center of Utah
• Tri-Valley Medical, LLC
• Michael Lee Tribe, D.D.S.
• Kay T Triplett, PT
• Tristan Inc.
• Dean Crispin Troili, D.D.S.
• Ashlee Trotter
• Kaleen Trout

• Intellectual Disabilities Intermediate Care Facility in Ogden, UT
• Providers in Ogden, UT by specialty
• Intellectual Disabilities Intermediate Care Facility in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2008; 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.