Healthcare Provider Details

I. General information

NPI: 1821287848
Provider Name (Legal Business Name): TRITON HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 10/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8128 FLORIDA BLVD
DENHAM SPRINGS LA
70726-7865
US

IV. Provider business mailing address

14339 MEADOW RIDGE WAY DR
BATON ROUGE LA
70817
US

V. Phone/Fax

Practice location:
  • Phone: 225-791-8666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number06714
License Number StateLA

VIII. Authorized Official

Name: JEFF DUNGAN
Title or Position: CEO
Credential:
Phone: 225-791-8666