Provider Demographics
NPI:1871253708
Name:TRINITY RECOVERY HEALTH & WELLNESS
Entity Type:Organization
Organization Name:TRINITY RECOVERY HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:N
Authorized Official - Last Name:MOURTACOS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-619-5250
Mailing Address - Street 1:7128 WARREN SHARON RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44403-9657
Mailing Address - Country:US
Mailing Address - Phone:330-619-5250
Mailing Address - Fax:330-619-5251
Practice Address - Street 1:7128 WARREN SHARON RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:OH
Practice Address - Zip Code:44403
Practice Address - Country:US
Practice Address - Phone:330-619-5250
Practice Address - Fax:330-619-5251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-20
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty