Provider Demographics
NPI:1417354317
Name:TRIDUUM HEALTHCARE SERVICES INCORPORATE
Entity Type:Organization
Organization Name:TRIDUUM HEALTHCARE SERVICES INCORPORATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:NGOZI
Authorized Official - Last Name:CHIKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-729-4618
Mailing Address - Street 1:7409 PENROD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-5421
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7409 PENROD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-5421
Practice Address - Country:US
Practice Address - Phone:313-729-4618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health