Healthcare Provider Details

I. General information

NPI: 1083938401
Provider Name (Legal Business Name): TRINITY IN HIS HOUSE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 E COMPTON BLVD
COMPTON CA
90221-3543
US

IV. Provider business mailing address

1806 E COMPTON BLVD
COMPTON CA
90221-3543
US

V. Phone/Fax

Practice location:
  • Phone: 909-234-7567
  • Fax: 310-763-3865
Mailing address:
  • Phone: 323-750-0092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. WENDELL J DAVIS SR.
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD
Phone: 909-234-7567