Healthcare Provider Details

I. General information

NPI: 1780918136
Provider Name (Legal Business Name): TRISOUTH - DURHAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 10/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 N DUKE ST STE 103
DURHAM NC
27704-1709
US

IV. Provider business mailing address

PO BOX 242036
CHARLOTTE NC
28224-2036
US

V. Phone/Fax

Practice location:
  • Phone: 919-471-1800
  • Fax: 919-471-1877
Mailing address:
  • Phone: 704-525-2505
  • Fax: 704-525-2506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: VERONICA SOUTHERLAND
Title or Position: ADMINISTRATOR
Credential: RN, BSW
Phone: 704-525-2505