1780744706 NPI number — TRINITY BEHAVIORAL CARE

Table of content: (NPI 1780744706)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780744706 NPI number — TRINITY BEHAVIORAL CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRINITY BEHAVIORAL CARE
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:
Provider Other Organization Name Type Code:
6
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:
1780744706
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1011
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARION
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29571-1011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-423-7876
Provider Business Mailing Address Fax Number:
843-423-8273

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
370 W SELLERS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARION
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29571-6093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-423-7876
Provider Business Practice Location Address Fax Number:
843-423-8273
Provider Enumeration Date:
12/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
O'CONNOR
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
T.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
843-423-8292

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  ITP-005 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , with the licence number: ITP-005 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: AD20MD , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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