Healthcare Provider Details

I. General information

NPI: 1174643514
Provider Name (Legal Business Name): TRIAD TREATMENT HOMES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N EDGEWORTH ST SUITE 105
GREENSBORO NC
27401-2182
US

IV. Provider business mailing address

415 N EDGEWORTH ST SUITE 105
GREENSBORO NC
27401-2182
US

V. Phone/Fax

Practice location:
  • Phone: 336-574-2404
  • Fax: 336-574-2405
Mailing address:
  • Phone: 336-574-2404
  • Fax: 336-574-2405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. PAMELA MYRICK BARRIER
Title or Position: EXECUTIVE DIRECTOR
Credential: BA, QP
Phone: 336-574-2404