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General NPI Number Information
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NPI Number | 1841853256
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Entity Type | Organization
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Legal Business Name | TRINITY RECOVERY LP
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Dates
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Enumeration Date | 04/22/2019
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 7128 WARREN SHARON RD
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City | BROOKFIELD
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State | OH
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Zip | 44403-9657
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Country | US
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Telephone | 330-619-5250
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Fax | 330-619-5251
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Provider Business Mailing Address
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Address Line | 7128 WARREN SHARON RD
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City | BROOKFIELD
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State | OH
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Zip | 44403-9657
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Country | US
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Telephone | 330-619-5250
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Fax | 330-619-5251
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Authorized Official
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Title or Position | CO-OWNER/PHYSICIAN
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Name | DR. HEATHER MOURTACOS
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Credential | DO
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Telephone | 330-619-5250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LA0401X
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Taxonomy Name | Addiction Medicine (Anesthesiology) Physician
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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 | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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