Provider Demographics
NPI:1144987835
Name:KAIROS OPPORTUNITY PROJECT
Entity type:Organization
Organization Name:KAIROS OPPORTUNITY PROJECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRISTEN
Authorized Official - Middle Name:MONROE
Authorized Official - Last Name:BRINLEE-TROYYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-600-4162
Mailing Address - Street 1:3266 SPRUCE VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75233-2537
Mailing Address - Country:US
Mailing Address - Phone:469-928-6176
Mailing Address - Fax:
Practice Address - Street 1:3266 SPRUCE VALLEY LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75233-2537
Practice Address - Country:US
Practice Address - Phone:469-928-6176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty