Tri-Support Services

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

3409089 Issued in NC

Legal business name

TRI-SUPPORT SERVICES

Practice address

8768 Van Hoy Rd
Kernersville, NC 27284-9249

Phone

(336) 501-1937

NPI assigned

Jan 9, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Michael L. Idol Jr.

Title

Business Manager

Phone

(336) 501-1937

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• CM Services Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521417600000",
    "number": "1164571535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8768 VAN HOY RD",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272849249",
            "telephone_number": "336-501-1937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8768 VAN HOY RD",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272849249",
            "telephone_number": "336-501-1937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-SUPPORT SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-09",
        "last_updated": "2018-03-19",
        "status": "A",
        "authorized_official_last_name": "IDOL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "336-501-1937",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "3409089",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3409089",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CM Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Kernersville, NC
• Providers in Kernersville, NC by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.