MEDICARE: TRI CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency		NY

General Provider Information

NPI Number	:	1225281561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI CENTER INC

Provider Business Mailing Address
First Line	:	1369 BROADWAY
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10018-7200
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2488 GRAND CONCOURSE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-5203
Country	:	US
Telephone Number	:	718-584-7204
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. JOE GONZALEZ
Credential	:
Telephone Number	:	212-268-8830

Provider Enumeration Date	:	10/30/2008
Last Update Date	:	10/30/2008

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