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General NPI Number Information
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NPI Number | 1548658255
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Entity Type | Organization
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Legal Business Name | TRIAD PEDIATRIC HOME HEALTH, LLC
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Dates
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Enumeration Date | 01/05/2015
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Last Update Date | 01/05/2015
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Provider Practice Location Address
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Address Line | 6111 SHOAL CREEK TRL
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City | GARLAND
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State | TX
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Zip | 75044-3843
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Country | US
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Telephone | 214-422-6904
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Fax |
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Provider Business Mailing Address
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Address Line | 6111 SHOAL CREEK TRL
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City | GARLAND
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State | TX
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Zip | 75044-3843
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Country | US
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Telephone | 214-422-6904
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. EZEQUIEL VALDEZ
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Credential |
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Telephone | 214-422-6904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 802112451
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License Number State | TX
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