Provider Demographics
NPI:1154796134
Name:TRINITY FAMILY SUPPORT LLC
Entity type:Organization
Organization Name:TRINITY FAMILY SUPPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:304-419-4100
Mailing Address - Street 1:3744 TEAYS VALLEY RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-8755
Mailing Address - Country:US
Mailing Address - Phone:304-419-4100
Mailing Address - Fax:
Practice Address - Street 1:3744 TEAYS VALLEY RD
Practice Address - Street 2:SUITE 210
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-8755
Practice Address - Country:US
Practice Address - Phone:304-419-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAP00943974251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management