Provider Demographics
NPI:1083921795
Name:TRIAD HOME HEALTH LLC
Entity Type:Organization
Organization Name:TRIAD HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:WOODRESS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:580-782-5800
Mailing Address - Street 1:129 N PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:MANGUM
Mailing Address - State:OK
Mailing Address - Zip Code:73554-4221
Mailing Address - Country:US
Mailing Address - Phone:580-782-5800
Mailing Address - Fax:580-782-5803
Practice Address - Street 1:129 N PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:MANGUM
Practice Address - State:OK
Practice Address - Zip Code:73554-4221
Practice Address - Country:US
Practice Address - Phone:580-782-5800
Practice Address - Fax:580-782-5803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-02
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKHC-7955251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health