Healthcare Provider Details

I. General information

NPI: 1255845764
Provider Name (Legal Business Name): TRINITY HEALTH AND SOCIAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2017
Last Update Date: 11/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N BLACK HORSE PIKE STE C
BLACKWOOD NJ
08012-3042
US

IV. Provider business mailing address

100 N BLACK HORSE PIKE STE C
BLACKWOOD NJ
08012-3042
US

V. Phone/Fax

Practice location:
  • Phone: 856-889-5172
  • Fax: 856-228-1934
Mailing address:
  • Phone: 856-889-5172
  • Fax: 856-228-1934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. PAUL ONUOHA
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 856-889-5172