Provider Demographics
NPI:1194140699
Name:TRIPLE PLAY FARM, LLC
Entity type:Organization
Organization Name:TRIPLE PLAY FARM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:DEBOLT
Authorized Official - Last Name:BATCHELOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-608-8441
Mailing Address - Street 1:19516 KISTLER FARM RD
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-9067
Mailing Address - Country:US
Mailing Address - Phone:704-608-8441
Mailing Address - Fax:
Practice Address - Street 1:19516 KISTLER FARM RD
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-9067
Practice Address - Country:US
Practice Address - Phone:704-608-8441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health