Provider Demographics
NPI:1780941104
Name:TRINITI HOUSE OF RESTORATION
Entity type:Organization
Organization Name:TRINITI HOUSE OF RESTORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-814-4100
Mailing Address - Street 1:485 MARLBORO DR
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-9409
Mailing Address - Country:US
Mailing Address - Phone:252-814-4100
Mailing Address - Fax:252-364-8292
Practice Address - Street 1:485 MARLBORO DRIVE
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590
Practice Address - Country:US
Practice Address - Phone:252-814-4100
Practice Address - Fax:252-364-8292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility