Healthcare Provider Details

I. General information

NPI: 1629108071
Provider Name (Legal Business Name): TRIAD ADULT DAY CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 E FAIRFIELD RD SUITE A
HIGH POINT NC
27263-2281
US

IV. Provider business mailing address

409 E FAIRFIELD RD SUITE A
HIGH POINT NC
27263-2281
US

V. Phone/Fax

Practice location:
  • Phone: 336-431-1537
  • Fax: 336-431-8128
Mailing address:
  • Phone: 336-431-1537
  • Fax: 336-431-8128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberMHL-041-1084
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL-041-1084
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberMHL-041-1084
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License NumberMHL-041-1084
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberMHL-041-987
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberMHL-041-987
License Number StateNC
# 7
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberMHL-041-987
License Number StateNC
# 8
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberMHL-041-813
License Number StateNC

VIII. Authorized Official

Name: MS. LASONYA VANEATON
Title or Position: DIRECTOR
Credential: QP
Phone: 336-431-1537