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General NPI Number Information
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NPI Number | 1386887693
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Entity Type | Organization
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Legal Business Name | TRINITY III, INC.
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Dates
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Enumeration Date | 04/16/2009
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Last Update Date | 04/16/2009
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Provider Practice Location Address
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Address Line | 607 E GROVER ST
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City | SHELBY
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State | NC
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Zip | 28150-4033
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Country | US
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Telephone | 704-482-0901
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 477
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City | SHELBY
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State | NC
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Zip | 28151-0477
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GWEN FOX
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Credential |
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Telephone | 704-482-0901
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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 | MHL023043
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License Number State | NC
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