Provider Demographics
NPI:1841853256
Name:TRINITY RECOVERY LP
Entity type:Organization
Organization Name:TRINITY RECOVERY LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MOURTACOS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-619-5250
Mailing Address - Street 1:7128 WARREN SHARON RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44403-9657
Mailing Address - Country:US
Mailing Address - Phone:330-619-5250
Mailing Address - Fax:330-619-5251
Practice Address - Street 1:7128 WARREN SHARON RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:OH
Practice Address - Zip Code:44403-9657
Practice Address - Country:US
Practice Address - Phone:330-619-5250
Practice Address - Fax:330-619-5251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-22
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction MedicineGroup - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty