Provider Demographics
NPI:1164801445
Name:TRP COMMUNITY RESOURCE DEVELOPMENT CORPORATION
Entity Type:Organization
Organization Name:TRP COMMUNITY RESOURCE DEVELOPMENT CORPORATION
Other - Org Name:WOUND CARE ASSISTANCE PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPUTY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MYISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-400-4051
Mailing Address - Street 1:9374 OLIVE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-3253
Mailing Address - Country:US
Mailing Address - Phone:314-991-8808
Mailing Address - Fax:
Practice Address - Street 1:9374 OLIVE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-3253
Practice Address - Country:US
Practice Address - Phone:314-400-1051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDIPLEX
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Single Specialty