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General NPI Number Information
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NPI Number | 1154149862
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Entity Type | Organization
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Legal Business Name | TRINITY RESIDENTIAL SERVICES, LLC
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Dates
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Enumeration Date | 10/01/2024
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 35 GUARANTEE ST
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City | PETERSBURG
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State | VA
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Zip | 23803-4101
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Country | US
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Telephone | 804-564-4173
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Fax |
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Provider Business Mailing Address
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Address Line | 8813 PROCTORS RUN DR
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City | RICHMOND
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State | VA
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Zip | 23237-2774
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Country | US
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Telephone | 804-564-4173
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. SHEDRICK MCCALL JR.
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Credential | ED.D.
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Telephone | 804-564-4173
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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