Provider Demographics
NPI:1053679399
Name:TRIAD SAFE CHOICE MOBILITY LLC
Entity Type:Organization
Organization Name:TRIAD SAFE CHOICE MOBILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THEO
Authorized Official - Middle Name:LEANDER
Authorized Official - Last Name:KIRKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-987-9393
Mailing Address - Street 1:945 YELLOWSTONE LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4027
Mailing Address - Country:US
Mailing Address - Phone:336-987-9393
Mailing Address - Fax:
Practice Address - Street 1:945 YELLOWSTONE LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-4027
Practice Address - Country:US
Practice Address - Phone:336-987-9393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)