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General NPI Number Information
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NPI Number | 1033398607
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Entity Type | Organization
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Legal Business Name | TRIAD COMMUNITY SERVICES, INC.
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Dates
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Enumeration Date | 10/30/2007
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Last Update Date | 10/30/2007
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Provider Practice Location Address
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Address Line | 1108 GRECADE ST
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City | GREENSBORO
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State | NC
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Zip | 27408-8729
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Country | US
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Telephone | 336-510-7464
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 95
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City | JAMESTOWN
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State | NC
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Zip | 27282-0095
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | MR. ANTOINE PRYOR
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Credential |
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Telephone | 336-510-7464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | NC
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