Healthcare Provider Details

I. General information

NPI: 1316223993
Provider Name (Legal Business Name): TRG HEALTH CARE SYSTEMS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 N BROAD ST
EDENTON NC
27932-1405
US

IV. Provider business mailing address

PO BOX 1207
WAKE FOREST NC
27588-1207
US

V. Phone/Fax

Practice location:
  • Phone: 919-556-4440
  • Fax:
Mailing address:
  • Phone: 919-556-4440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: EULANDA ELLIOTT
Title or Position: PRESIDENT
Credential:
Phone: 919-925-3604