Healthcare Provider Details

I. General information

NPI: 1063942167
Provider Name (Legal Business Name): TRIAD BEHAVIOR SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E MAIN ST STE 207
CARNEGIE PA
15106-2437
US

IV. Provider business mailing address

150 E MAIN ST STE 207
CARNEGIE PA
15106-2437
US

V. Phone/Fax

Practice location:
  • Phone: 412-429-1908
  • Fax: 412-429-0800
Mailing address:
  • Phone: 412-429-1908
  • Fax: 412-429-0800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: HEATHER BETTS
Title or Position: CEO
Credential:
Phone: 412-429-1908