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General NPI Number Information
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NPI Number | 1053495523
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Entity Type | Organization
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Legal Business Name | TRINITY WILL GROUP
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 01/02/2008
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Provider Practice Location Address
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Address Line | 140 FAULKNER LN
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City | ROSEBORO
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State | NC
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Zip | 28382-5415
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Country | US
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Telephone | 910-525-5035
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Fax | 910-525-5065
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Provider Business Mailing Address
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Address Line | PO BOX 618
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City | CLINTON
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State | NC
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Zip | 28329-0618
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Country | US
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Telephone | 910-590-2971
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Fax | 910-596-2971
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. SHIRLEY MELINDA WILLIAMS
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Credential |
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Telephone | 910-525-5035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | MHL082046
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License Number State | NC
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