Healthcare Provider Details

I. General information

NPI: 1023976669
Provider Name (Legal Business Name): TRIAD RECOVERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 CHARLOIS BLVD STE 310
WINSTON SALEM NC
27103-1549
US

IV. Provider business mailing address

150 CHARLOIS BLVD STE 310
WINSTON SALEM NC
27103-1549
US

V. Phone/Fax

Practice location:
  • Phone: 617-417-5040
  • Fax:
Mailing address:
  • Phone: 617-417-5040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRIS M DORVAL
Title or Position: EXECUTIVE DIRECTOR
Credential: LICSW
Phone: 401-626-0169