Provider Demographics
NPI:1225176621
Name:TRAUMA RESOLUTION CENTER INC
Entity Type:Organization
Organization Name:TRAUMA RESOLUTION CENTER INC
Other - Org Name:VICTIM SERVICES CENTER, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:DESCILO
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:305-374-9990
Mailing Address - Street 1:3000 BISCAYNE BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-4130
Mailing Address - Country:US
Mailing Address - Phone:305-374-9990
Mailing Address - Fax:305-374-9995
Practice Address - Street 1:3000 BISCAYNE BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-4130
Practice Address - Country:US
Practice Address - Phone:305-374-9990
Practice Address - Fax:305-374-9995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1113AD774101261QM0801X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0761273 00Medicaid