Provider Demographics
NPI:1407539745
Name:TRAVCARE LLC
Entity Type:Organization
Organization Name:TRAVCARE LLC
Other - Org Name:TRAVCARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LATWAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:DHS QMHPA MATC
Authorized Official - Phone:757-920-2765
Mailing Address - Street 1:1717 HOLLADAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-2015
Mailing Address - Country:US
Mailing Address - Phone:757-920-2765
Mailing Address - Fax:
Practice Address - Street 1:1717 HOLLADAY ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-2015
Practice Address - Country:US
Practice Address - Phone:757-920-2765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-14
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty