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General NPI Number Information
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NPI Number | 1154796134
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Entity Type | Organization
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Legal Business Name | TRINITY FAMILY SUPPORT LLC
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Dates
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Enumeration Date | 12/02/2015
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Last Update Date | 12/02/2015
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Provider Practice Location Address
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Address Line | 3744 TEAYS VALLEY RD SUITE 210
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City | HURRICANE
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State | WV
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Zip | 25526-8755
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Country | US
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Telephone | 304-419-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 3744 TEAYS VALLEY RD SUITE 210
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City | HURRICANE
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State | WV
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Zip | 25526-8755
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Country | US
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Telephone | 304-419-4100
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MIKKI OWENS
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Credential | LSW
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Telephone | 304-419-4100
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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 | AP00943974
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License Number State | WV
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