Provider Demographics
NPI:1669938528
Name:TRINITY CHAPEL INCORPORATED
Entity type:Organization
Organization Name:TRINITY CHAPEL INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:TIDD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-481-1570
Mailing Address - Street 1:4448 N US HIGHWAY 52
Mailing Address - Street 2:
Mailing Address - City:THORNTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46071-9289
Mailing Address - Country:US
Mailing Address - Phone:765-481-1570
Mailing Address - Fax:
Practice Address - Street 1:4448 N US HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:THORNTOWN
Practice Address - State:IN
Practice Address - Zip Code:46071-9289
Practice Address - Country:US
Practice Address - Phone:765-481-1570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility