MEDICARE: TRIALITY, 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	251S00000X	Community/Behavioral Health Agency
2	261QA0600X	Adult Day Care Clinic/Center	292766508	MO
3	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659414506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIALITY, INC.

Provider Business Mailing Address
First Line	:	6600 A ROYAL STREET
Second Line	:	SUITE 105
City	:	PLEASANT VALLEY
State	:	MO
Zip	:	64068
Country	:	US
Telephone Number	:	816-781-0177
Fax Number	:	816-781-9271

Provider Business Practice Location Address
First Line	:	6600 A ROYAL STREET
Second Line	:	SUITE 105
City	:	PLEASANT VALLEY
State	:	MO
Zip	:	64068
Country	:	US
Telephone Number	:	816-781-0177
Fax Number	:	816-781-0177

Authorized Official
Title or Position	:	VICE PRESIDENT, CFO
Name	:	MR. JOHN W. ADKINS
Credential	:
Telephone Number	:	314-394-7100

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	02/23/2015

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Directions to “TRIALITY, INC. ” Practice Location

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