Provider Demographics
NPI:1376825752
Name:TRI COUNTY GROUP HOMES INC
Entity Type:Organization
Organization Name:TRI COUNTY GROUP HOMES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-259-4987
Mailing Address - Street 1:4140 COUNTY RD 43
Mailing Address - Street 2:
Mailing Address - City:FYFFE
Mailing Address - State:AL
Mailing Address - Zip Code:35971-4655
Mailing Address - Country:US
Mailing Address - Phone:256-259-4987
Mailing Address - Fax:
Practice Address - Street 1:868 COUNTY ROAD 529
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-6916
Practice Address - Country:US
Practice Address - Phone:256-259-6851
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities