Provider Demographics
NPI:1164485074
Name:TRI COUNTY HUMAN SERVICES, INC.
Entity Type:Organization
Organization Name:TRI COUNTY HUMAN SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:BLAIR
Authorized Official - Last Name:GELDART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-533-4139
Mailing Address - Street 1:1815 CRYSTAL LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-5979
Mailing Address - Country:US
Mailing Address - Phone:863-709-9392
Mailing Address - Fax:863-709-8923
Practice Address - Street 1:2725 HWY 60 E
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-8872
Practice Address - Country:US
Practice Address - Phone:863-533-5860
Practice Address - Fax:863-533-5272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility