1588833701 NPI number — TRIAD THERAPY MENTAL HEALTH CENTER

Table of content: (NPI 1588833701)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588833701 NPI number — TRIAD THERAPY MENTAL HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRIAD THERAPY MENTAL HEALTH CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588833701
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
350 N COX ST STE 16
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHEBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27203-5514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-629-7774
Provider Business Mailing Address Fax Number:
336-629-7776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
N WILKESBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28659-4401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-990-9252
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SMILING
Authorized Official First Name:
QUINCY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
336-896-0904

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 641001 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com