MEDICARE: TRINITY BEHAVIORAL HEALTHCARE PC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1184176117
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY BEHAVIORAL HEALTHCARE PC

Provider Business Mailing Address
First Line	:	2716 TROXLER RD
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27215-9187
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2505 FAIRVIEW ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27405-4919
Country	:	US
Telephone Number	:	336-570-0104
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. SHAMSHER AHLUWALIA
Credential	:	M.D.
Telephone Number	:	336-570-0104

Provider Enumeration Date	:	10/25/2016
Last Update Date	:	10/25/2016

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