Basic Information
| Provider Information | |||||||||
| NPI: | 1073768222 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRI CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2488 GRAND CONCOURSE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104585203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185847204 | ||||||||
| FaxNumber: | 7185848394 | ||||||||
| Practice Location | |||||||||
| Address1: | 2488 GRAND CONCOURSE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104585203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185847204 | ||||||||
| FaxNumber: | 7185848394 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2008 | ||||||||
| LastUpdateDate: | 12/01/2008 | ||||||||
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| AuthorizedOfficialLastName: | FARRELL | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SUBSTANCE ABUSE COUNSELOR | ||||||||
| AuthorizedOfficialTelephone: | 7185847204 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | SR. | ||||||||
| AuthorizedOfficialCredential: | CASAC-T | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.