Provider Demographics
NPI:1891122743
Name:TRI-CITY CARE SERVICES,LLC
Entity Type:Organization
Organization Name:TRI-CITY CARE SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AKWASI
Authorized Official - Middle Name:BOAFO
Authorized Official - Last Name:PEPRAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-218-2933
Mailing Address - Street 1:3238 BELDEN TER
Mailing Address - Street 2:APT 322
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-1940
Mailing Address - Country:US
Mailing Address - Phone:510-931-0922
Mailing Address - Fax:
Practice Address - Street 1:3238 BELDEN TER
Practice Address - Street 2:APT 322
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-1940
Practice Address - Country:US
Practice Address - Phone:510-931-0922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-07
Last Update Date:2013-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA201323110187302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization