Provider Demographics
NPI:1093304156
Name:PIEDMONT TRIAD REGIONAL DEVELOPMENT CORPORATION
Entity Type:Organization
Organization Name:PIEDMONT TRIAD REGIONAL DEVELOPMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-904-0300
Mailing Address - Street 1:1398 CARROLLTON CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-3896
Mailing Address - Country:US
Mailing Address - Phone:336-904-0300
Mailing Address - Fax:336-904-0336
Practice Address - Street 1:1398 CARROLLTON CROSSING DR
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-3896
Practice Address - Country:US
Practice Address - Phone:336-904-0300
Practice Address - Fax:336-904-0336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty