1477736007 NPI number — TRINITY SUPPORT SERVICES LLC

Table of content: (NPI 1477736007)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477736007 NPI number — TRINITY SUPPORT SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRINITY SUPPORT SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TRINITY RESTORATION CENTER
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477736007
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2532
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURLINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27216-2532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-513-2204
Provider Business Mailing Address Fax Number:
336-513-2208

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1717 GAVIN DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGH POINT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27260-5506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-889-6905
Provider Business Practice Location Address Fax Number:
336-889-6905
Provider Enumeration Date:
12/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SALAAM
Authorized Official First Name:
SUZANNE
Authorized Official Middle Name:
SALAAM
Authorized Official Title or Position:
PROGRAM DIRECTOR
Authorized Official Telephone Number:
336-491-5423

Provider Taxonomy Codes

  • Taxonomy code: 322D00000X , with the licence number:  MHL-041-839 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MHL-041-839 . This is a "STATE LICENSE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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