| Divine Trinity Outreach Center | |
|
2544 Hernando Rd Memphis TN 38106-8314 | |
| (901) 265-6146 | |
| Not Available |
| Full Name | Divine Trinity Outreach Center |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2544 Hernando Rd, Memphis, Tennessee |
| Authorized Official Name and Position | Annie Mae Ivory (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9012656146 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Divine Trinity Outreach Center 2544 Hernando Rd Memphis TN 38106-8314 Ph: (901) 249-4959 | Divine Trinity Outreach Center 2544 Hernando Rd Memphis TN 38106-8314 Ph: (901) 265-6146 |
| NPI Number | 1861050882 |
|---|---|
| Provider Enumeration Date | 06/04/2019 |
| Last Update Date | 01/05/2023 |
| Certification Date | 01/05/2023 |
| Medicare PECOS PAC ID | 1759793540 |
|---|---|
| Medicare Enrollment ID | O20240916000175 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861050882 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Michael Valdes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841544178 PECOS PAC ID: 2961829254 Enrollment ID: I20200901002574 |
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