Organization
DE TRINITY COMMUNITY LIVING CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EJOVWOKE RIESA (CEO)
(646) 400-4562
Entity
Organization
Contact information
Practice address
25 GORDON RD, MIDDLETOWN, NY 10941-3346
(646) 400-4562
(347) 274-2478
Mailing address
25 GORDON RD, MIDDLETOWN, NY 10941-3346
(646) 400-4562
(347) 274-2478
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
11/15/2017
Last updated
01/20/2023
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