Healthcare Provider Details

I. General information

NPI: 1245093095
Provider Name (Legal Business Name): THREE FAMILY SUPPORT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 02/05/2024
Certification Date: 02/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 STONECLIFFE DR
MONROEVILLE PA
15146-3203
US

IV. Provider business mailing address

102 SPRING GROVE RD
PITTSBURGH PA
15235-1804
US

V. Phone/Fax

Practice location:
  • Phone: 412-579-2094
  • Fax:
Mailing address:
  • Phone: 412-579-2094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: DR. THERONE WADE-WHITE SR.
Title or Position: CEO
Credential: PHD
Phone: 412-579-2094