Organization
TRINITY WILL GROUP
Active
Other names
Jireh Haven
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHIRLEY MELINDA WILLIAMS (EXECUTIVE DIRECTOR)
(910) 525-5035
Entity
Organization
Contact information
Practice address
140 FAULKNER LN, ROSEBORO, NC 28382-5415
(910) 525-5035
(910) 525-5065
Mailing address
PO BOX 618, CLINTON, NC 28329-0618
(910) 590-2971
(910) 596-2971
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL082046
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6603564
—
NC
Enumeration date
10/24/2006
Last updated
01/02/2008
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