Provider Demographics
NPI:1184830887
Name:TRIAD HOME HEALTH AGENCY
Entity Type:Organization
Organization Name:TRIAD HOME HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:T
Authorized Official - Last Name:LIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-275-7328
Mailing Address - Street 1:1706 RAYSTON DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-5243
Mailing Address - Country:US
Mailing Address - Phone:336-275-7328
Mailing Address - Fax:336-272-6359
Practice Address - Street 1:1706 RAYSTON DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-5243
Practice Address - Country:US
Practice Address - Phone:336-275-7328
Practice Address - Fax:336-272-6359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHCI-1626251E00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCHCI-1626Medicaid