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General NPI Number Information
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NPI Number | 1568260131
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Entity Type | Organization
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Legal Business Name | TRIAD PLAY
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Dates
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Enumeration Date | 03/07/2025
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 429 GILLESPIE ST
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City | GREENSBORO
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State | NC
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Zip | 27401-3628
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Country | US
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Telephone | 336-303-1723
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Fax |
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Provider Business Mailing Address
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Address Line | 2941 BATTLEGROUND AVE # 39684
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City | GREENSBORO
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State | NC
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Zip | 27408-2705
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Country | US
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Telephone | 510-485-4225
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | KAMILAH USORO
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Credential | MED
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Telephone | 510-485-4225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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