| De Trinity Community Living Corp. | |
|
25 Gordon Rd Middletown NY 10941-3346 | |
| (646) 400-4562 | |
| Not Available |
| Full Name | De Trinity Community Living Corp. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 25 Gordon Rd, Middletown, New York |
| Authorized Official Name and Position | Ejovwoke Riesa (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6464004562 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| De Trinity Community Living Corp. 25 Gordon Rd Middletown NY 10941-3346 Ph: (646) 400-4562 | De Trinity Community Living Corp. 25 Gordon Rd Middletown NY 10941-3346 Ph: (646) 400-4562 |
| NPI Number | 1083198501 |
|---|---|
| Provider Enumeration Date | 09/20/2018 |
| Last Update Date | 01/20/2023 |
| Certification Date | 01/20/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083198501 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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