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General NPI Number Information
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NPI Number | 1083977318
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Entity Type | Organization
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Legal Business Name | TRIAD HEALTH AND WELLNESS FOUNDATION
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Dates
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Enumeration Date | 06/21/2012
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Last Update Date | 06/21/2012
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Provider Practice Location Address
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Address Line | 5925 W FRIENDLY AVE SUITE 205
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City | GREENSBORO
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State | NC
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Zip | 27410-3207
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Country | US
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Telephone | 336-856-1570
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Fax | 336-510-1496
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Provider Business Mailing Address
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Address Line | 5925 WEST FRIENDLY AVENUE SUITE 205
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City | GREENSBORO
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State | NC
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Zip | 27410-3207
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Country | US
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Telephone | 336-856-1570
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Fax | 336-510-1496
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Authorized Official
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Title or Position | MANAGER
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Name | DR. TEENA FAY MCBRIDE
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Credential | NUTRITIONIST
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Telephone | 336-856-1570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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