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General NPI Number Information
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NPI Number | 1083938401
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Entity Type | Organization
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Legal Business Name | TRINITY IN HIS HOUSE FOUNDATION
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Dates
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Enumeration Date | 03/15/2010
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Last Update Date | 03/15/2010
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Provider Practice Location Address
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Address Line | 1806 E COMPTON BLVD
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City | COMPTON
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State | CA
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Zip | 90221-3543
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Country | US
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Telephone | 909-234-7567
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Fax | 310-763-3865
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Provider Business Mailing Address
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Address Line | 1806 E COMPTON BLVD
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City | COMPTON
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State | CA
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Zip | 90221-3543
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Country | US
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Telephone | 323-750-0092
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. WENDELL J DAVIS SR.
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Credential | PHD
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Telephone | 909-234-7567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State |
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