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General NPI Number Information
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NPI Number | 1508005885
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Entity Type | Organization
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Legal Business Name | TRINITY III FAMILY OUTREACH
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Dates
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Enumeration Date | 02/11/2009
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Last Update Date | 08/05/2011
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Provider Practice Location Address
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Address Line | 108 SPRUANCE RD
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City | DOVER
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State | DE
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Zip | 19901-4051
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Country | US
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Telephone | 804-931-8910
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Fax | 804-931-8910
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Provider Business Mailing Address
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Address Line | 1501 LITTLE GLOUCESTER RD APT F2
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City | BLACKWOOD
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State | NJ
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Zip | 08012-3445
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Country | US
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Telephone | 804-931-5910
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CARY RICHARD FOX
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Credential | B.S
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Telephone | 804-931-8910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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