Provider Demographics
NPI:1083445415
Name:TRINITY BEHAVIORAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:TRINITY BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FON
Authorized Official - Middle Name:
Authorized Official - Last Name:EMBOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-304-0840
Mailing Address - Street 1:2841 E TYSON ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-4244
Mailing Address - Country:US
Mailing Address - Phone:480-304-0840
Mailing Address - Fax:
Practice Address - Street 1:2841 E TYSON ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-4244
Practice Address - Country:US
Practice Address - Phone:480-304-0840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit