=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598863284
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRIAD HEALTH PROJECT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 801 SUMMIT AVE
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27405-7856
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-275-1654
-----------------------------------------------------
Fax | 336-275-2209
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5716
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27435-0716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-275-1654
-----------------------------------------------------
Fax | 336-275-2209
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. VIRGINA ADDISON ORE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 336-275-1654
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------