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General NPI Number Information
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NPI Number | 1538312913
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Entity Type | Organization
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Legal Business Name | TRITON HEALTHCARE
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Dates
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Enumeration Date | 10/29/2008
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Last Update Date | 10/29/2008
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Provider Practice Location Address
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Address Line | 106 KILBOURNE CIR
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City | CARENCRO
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State | LA
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Zip | 70520-5348
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Country | US
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Telephone | 337-896-5885
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Fax |
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Provider Business Mailing Address
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Address Line | 106 KILBOURNE CIR
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City | CARENCRO
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State | LA
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Zip | 70520-5348
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Country | US
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Telephone | 337-896-5885
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MS. KATHLEEN SANTILLO
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Credential | RPT
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Telephone | 337-962-2349
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 00556
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License Number State | LA
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