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General NPI Number Information
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NPI Number | 1225164387
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Entity Type | Organization
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Legal Business Name | TRINITY INNOVATIVE PROGRAMMING SERVICES, INC.
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Dates
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Enumeration Date | 02/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1631 KARA CT
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-2052
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Country | US
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Telephone | 910-717-0504
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Fax | 910-717-0536
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Provider Business Mailing Address
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Address Line | 1631 KARA CT
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-2052
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Country | US
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Telephone | 910-717-0504
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Fax | 910-717-0536
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Authorized Official
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Title or Position | CEO
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Name | MR. DARIUS CHARELL MONROE
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Credential | BA
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Telephone | 910-583-1890
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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 | C005569
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License Number State | NC
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