Provider Demographics
NPI:1073780896
Name:TRIANGLE RESIDENTIAL OPTIONS FOR SUBSTANCE ABUSERS
Entity Type:Organization
Organization Name:TRIANGLE RESIDENTIAL OPTIONS FOR SUBSTANCE ABUSERS
Other - Org Name:TROSA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-419-1059
Mailing Address - Street 1:1820 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2024
Mailing Address - Country:US
Mailing Address - Phone:919-419-1059
Mailing Address - Fax:919-490-1930
Practice Address - Street 1:1820 JAMES ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2024
Practice Address - Country:US
Practice Address - Phone:919-419-1059
Practice Address - Fax:919-490-1930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-032-363324500000X
NCMHL-032-361324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility