Provider Demographics
NPI:1740056118
Name:TRIDENT SERVICES, LLC
Entity type:Organization
Organization Name:TRIDENT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:KRANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-687-2990
Mailing Address - Street 1:2003 GRAVES MILL RD STE C
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-4291
Mailing Address - Country:US
Mailing Address - Phone:434-687-2990
Mailing Address - Fax:434-687-2991
Practice Address - Street 1:2003 GRAVES MILL RD STE C
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-4291
Practice Address - Country:US
Practice Address - Phone:434-687-2990
Practice Address - Fax:434-687-2991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services