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General NPI Number Information
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NPI Number | 1376773770
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Entity Type | Organization
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Legal Business Name | TRINITY TEEN SOLUTIONS, INC
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Dates
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Enumeration Date | 07/20/2009
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Last Update Date | 03/16/2020
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Provider Practice Location Address
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Address Line | 112 SAFE HAVEN RD
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City | POWELL
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State | WY
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Zip | 82435-8163
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Country | US
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Telephone | 307-202-8400
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Fax | 307-462-0673
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Provider Business Mailing Address
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Address Line | 112 SAFE HAVEN RD
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City | POWELL
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State | WY
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Zip | 82435-8163
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Country | US
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Telephone | 307-202-8400
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Fax | 307-462-0673
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. ANGELA CAROL WOODWARD
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Credential | RN
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Telephone | 307-202-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | 4292005
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License Number State | WY
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