Provider Demographics
NPI:1417281866
Name:TRISOUTH - HIGH POINT
Entity Type:Organization
Organization Name:TRISOUTH - HIGH POINT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUTHERLAND
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSW
Authorized Official - Phone:704-525-2505
Mailing Address - Street 1:PO BOX 242036
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28224-2036
Mailing Address - Country:US
Mailing Address - Phone:704-525-2505
Mailing Address - Fax:704-525-2506
Practice Address - Street 1:110 SCOTT AVE STE 12
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-7813
Practice Address - Country:US
Practice Address - Phone:336-889-3371
Practice Address - Fax:800-406-0839
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRISOUTH HEALTH SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health