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General NPI Number Information
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NPI Number | 1902611148
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Entity Type | Organization
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Legal Business Name | THREE RIVERS RESIDENTIAL CARE LLC
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Dates
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Enumeration Date | 02/12/2025
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 4043 IRENE ST
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City | WEST MIFFLIN
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State | PA
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Zip | 15122-2069
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Country | US
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Telephone | 616-446-0271
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Fax |
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Provider Business Mailing Address
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Address Line | 12037 LEIGHTON CT
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City | CARMEL
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State | IN
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Zip | 46032-7345
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Country | US
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Telephone | 317-372-6611
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. KYLE SMALL
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Credential |
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Telephone | 317-372-6611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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