Organization
TRINITY HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT NGONGHOPONGHO FORLEMU MR. (ADMINISTRATOR/PROGRAM DIRECTOR)
(520) 270-7061
Entity
Organization
Contact information
Practice address
2384 E CAMINO MALCOTE, TUCSON, AZ 85706-5191
(520) 207-5196
(520) 203-7567
Mailing address
2384 E CAMINO MALCOTE, TUCSON, AZ 85706-5191
(520) 207-5196
(520) 203-7567
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH-3897
AZ
Other
Enumeration date
10/04/2010
Last updated
08/16/2011
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