MEDICARE: TRIARK LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1023975919
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIARK LLC

Provider Business Mailing Address
First Line	:	6308 PATRICIA DR
Second Line	:
City	:	MATTESON
State	:	IL
Zip	:	60443-3049
Country	:	US
Telephone Number	:	708-673-3761
Fax Number	:

Provider Business Practice Location Address
First Line	:	7951 CALUMET AVE # 1066
Second Line	:
City	:	MUNSTER
State	:	IN
Zip	:	46321-1215
Country	:	US
Telephone Number	:	708-673-3761
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. PATRICE CLOUTIER-DAVIS
Credential	:
Telephone Number	:	708-673-3761

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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Directions to “TRIARK LLC ” Practice Location

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