- Enrollment id
- O20231107000766
- Enrollment state
- KY
- Provider type code
- 00-04
- Provider type text
- PART A PROVIDER - FEDERALLY QUALIFIED HEALTH CENTER (FQHC)
- Npi
- 1508640038
- Multiple npi flag
- N
- Ccn
- B01101
- Associate id
- 6800243296
- Organization name
- TRINITY FAMILY HEALTH INC
- Incorporation date
- 2023-05-01
- Incorporation state
- KY
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 14949 N US HIGHWAY 25 E
- Address line 2
- STE 6
- City
- CORBIN
- State
- KY
- Zip code
- 407016285
- Telephone number
- 6062803011