Healthcare Provider Details

I. General information

NPI: 1447941604
Provider Name (Legal Business Name): TRIAD HOMECARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 UNIVERSITY DR N STE 320
FARGO ND
58102-4661
US

IV. Provider business mailing address

112 UNIVERSITY DR N STE 320
FARGO ND
58102-4661
US

V. Phone/Fax

Practice location:
  • Phone: 701-850-5492
  • Fax: 701-403-8914
Mailing address:
  • Phone: 701-850-5492
  • Fax: 701-403-8914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MISHAEL MBITHUKA
Title or Position: ADMINISTRATOR
Credential: RN-BSN
Phone: 701-850-0810