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General NPI Number Information
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NPI Number | 1750594420
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Entity Type | Organization
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Legal Business Name | TRIO COMMUNITY
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12706 CRESTMOOR CIR
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City | PROSPECT
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State | KY
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Zip | 40059-9181
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Country | US
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Telephone | 270-993-4388
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Fax |
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Provider Business Mailing Address
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Address Line | 12706 CRESTMOOR CIR
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City | PROSPECT
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State | KY
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Zip | 40059-9181
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Country | US
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Telephone | 270-993-4388
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DREW HAYNES
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Credential |
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Telephone | 270-993-4388
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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 | KY
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