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General NPI Number Information
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NPI Number | 1447763271
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Entity Type | Organization
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Legal Business Name | DE TRINITY COMMUNITY LIVING CORP
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Dates
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Enumeration Date | 11/15/2017
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Last Update Date | 01/20/2023
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Provider Practice Location Address
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Address Line | 25 GORDON RD
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City | MIDDLETOWN
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State | NY
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Zip | 10941-3346
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Country | US
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Telephone | 646-400-4562
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Fax | 347-274-2478
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Provider Business Mailing Address
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Address Line | 25 GORDON RD
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City | MIDDLETOWN
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State | NY
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Zip | 10941-3346
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Country | US
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Telephone | 646-400-4562
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Fax | 347-274-2478
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Authorized Official
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Title or Position | CEO
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Name | EJOVWOKE RIESA
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Credential |
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Telephone | 646-400-4562
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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