Healthcare Provider Details

I. General information

NPI: 1437441474
Provider Name (Legal Business Name): TRINITY HEALTH & WELLNESS SOLUTIONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 05/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 LEROY STREET
CHARLOTTE NC
28205
US

IV. Provider business mailing address

PO BOX 26351
CHARLOTTE NC
28221-6351
US

V. Phone/Fax

Practice location:
  • Phone: 704-890-1970
  • Fax: 518-690-1970
Mailing address:
  • Phone: 704-890-1970
  • Fax: 518-690-1970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JUANITA C JACKSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 704-890-1970