Provider Demographics
NPI:1780470930
Name:TRI-STATE CRISIS GUARD
Entity type:Organization
Organization Name:TRI-STATE CRISIS GUARD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOMONE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSON
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:757-329-1466
Mailing Address - Street 1:2827 TELEK PL APT 1234
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-4861
Mailing Address - Country:US
Mailing Address - Phone:757-329-1466
Mailing Address - Fax:
Practice Address - Street 1:2827 TELEK PL APT 1234
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-4861
Practice Address - Country:US
Practice Address - Phone:757-329-1466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive Care