Provider Demographics
NPI:1922358845
Name:TRIDENT BEHAVIORAL HEALTHCARE, INC.
Entity Type:Organization
Organization Name:TRIDENT BEHAVIORAL HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:352-232-0839
Mailing Address - Street 1:6131 US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-2527
Mailing Address - Country:US
Mailing Address - Phone:727-842-6900
Mailing Address - Fax:727-842-6902
Practice Address - Street 1:6133 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-2527
Practice Address - Country:US
Practice Address - Phone:727-842-6900
Practice Address - Fax:727-842-6902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health