Provider Demographics
NPI:1164852000
Name:TRINITY BEHAVIORAL CARE
Entity Type:Organization
Organization Name:TRINITY BEHAVIORAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BROCK
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:843-423-8292
Mailing Address - Street 1:103 NW COURT ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:SC
Mailing Address - Zip Code:29571-2901
Mailing Address - Country:US
Mailing Address - Phone:843-774-6591
Mailing Address - Fax:843-774-1409
Practice Address - Street 1:103 NW COURT ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:SC
Practice Address - Zip Code:29571-2901
Practice Address - Country:US
Practice Address - Phone:843-774-6591
Practice Address - Fax:843-774-1409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health