MEDICARE: TRINITY CARE OF THE CAROLINAS INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	MHL-084-055	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073654497
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY CARE OF THE CAROLINAS INCORPORATED

Provider Business Mailing Address
First Line	:	PO BOX 646
Second Line	:
City	:	ALBEMARLE
State	:	NC
Zip	:	28002-0646
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12673 US HWY 52 SOUTH
Second Line	:
City	:	NORWOOD
State	:	NC
Zip	:	28128-7434
Country	:	US
Telephone Number	:	704-474-7150
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MISS ARLOISHIA EVERSON
Credential	:
Telephone Number	:	980-581-1240

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	12/11/2009

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