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De Trinity Community Living Corp.

Community/Behavioral Health in Middletown, NY. Organization (NPI-2).

NPI number1083198501
StatusActive
Last updated in NPPESJan 20, 2023

Details

NPI
1083198501
Entity type
Organization (NPI-2)
Legal business name
De Trinity Community Living Corp.
Organization subpart
No
Enumeration date
Sep 20, 2018
Certification date
Jan 20, 2023
Last updated
Jan 20, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
251S00000X Community/Behavioral Health––Yes

Practice location

25 Gordon Rd
Middletown, NY 10941-3346

Phone 646-400-4562

Mailing address

25 Gordon Rd
Middletown, NY 10941-3346

Phone 646-400-4562

Authorized official

Ejovwoke Riesa
Executive Director
6464004562

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