Organization
TRIDENT SENIOR HEALTH CENTER
Active
Organization
TRIDENT SENIOR HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIM LLOYD (V.P.)
(843) 797-0416
Entity
Organization
Contact information
Practice address
2070 NORTHBROOK BLVD, #A16, CHARLESTON, SC 29406-9252
(843) 797-0416
Mailing address
2070 NORTHBROOK BLVD, #A16, CHARLESTON, SC 29406-9252
(843) 797-0416
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP1196
—
SC
Enumeration date
06/17/2006
Last updated
04/20/2008
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