Provider Demographics
NPI:1164571535
Name:TRI-SUPPORT SERVICES
Entity Type:Organization
Organization Name:TRI-SUPPORT SERVICES
Other - Org Name:CM SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:IDOL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:336-501-1937
Mailing Address - Street 1:8768 VAN HOY RD
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-9249
Mailing Address - Country:US
Mailing Address - Phone:336-501-1937
Mailing Address - Fax:
Practice Address - Street 1:8768 VAN HOY RD
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-9249
Practice Address - Country:US
Practice Address - Phone:336-501-1937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3409089320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409089Medicaid