Provider Demographics
NPI:1699816025
Name:TRINITY CARE OF THE CAROLINAS INCORPORATED
Entity Type:Organization
Organization Name:TRINITY CARE OF THE CAROLINAS INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:ARLOISHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:EVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-581-1240
Mailing Address - Street 1:PO BOX 646
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28002-0646
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:263 ANSON AVENUE
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:NC
Practice Address - Zip Code:28128-7434
Practice Address - Country:US
Practice Address - Phone:704-474-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-084-048322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6604004Medicaid