MEDICARE: TRIAD FAMILY SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000034CT	OTHER	CA	MEDI-CAL PROVIDER NUMBER

General Provider Information

NPI Number	:	1770672602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIAD FAMILY SERVICES

Provider Business Mailing Address
First Line	:	2445 ALBATROSS WAY
Second Line	:	SUITE 101
City	:	SACRAMENTO
State	:	CA
Zip	:	95815-2878
Country	:	US
Telephone Number	:	916-631-0771
Fax Number	:	916-631-0498

Provider Business Practice Location Address
First Line	:	2445 ALBATROSS WAY
Second Line	:	SUITE 101
City	:	SACRAMENTO
State	:	CA
Zip	:	95815-2878
Country	:	US
Telephone Number	:	916-631-0771
Fax Number	:	916-631-0498

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. DEAN COWAN
Credential	:
Telephone Number	:	916-914-7279

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	08/22/2020

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Directions to “TRIAD FAMILY SERVICES ” Practice Location

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