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General NPI Number Information
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NPI Number | 1538446232
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Entity Type | Organization
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Legal Business Name | TRIAD HEALTH CARE SERVICES #2
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Dates
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Enumeration Date | 11/08/2011
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Last Update Date | 11/08/2011
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Provider Practice Location Address
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Address Line | 603 PINNIX RD
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City | BURLINGTON
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State | NC
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Zip | 27217-8555
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Country | US
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Telephone | 336-280-0426
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3334
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City | BURLINGTON
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State | NC
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Zip | 27215-0334
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Country | US
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Telephone | 919-672-5815
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. BYRON KEITH WHITE
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Credential |
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Telephone | 919-672-5815
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | MHL-001-124
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License Number State | NC
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