Healthcare Provider Details

I. General information

NPI: 1760675839
Provider Name (Legal Business Name): TRI SUPPORT SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5307 BREKENWOOD RD
PLEASANT GARDEN NC
27313-8239
US

IV. Provider business mailing address

5307 BREKENWOOD RD
PLEASANT GARDEN NC
27313-8239
US

V. Phone/Fax

Practice location:
  • Phone: 336-373-0482
  • Fax:
Mailing address:
  • Phone: 336-373-0482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberMHL-041-769
License Number StateNC

VIII. Authorized Official

Name: MS. SHARON ALTMAN
Title or Position: OWNER
Credential:
Phone: 336-373-0480