Provider Demographics
NPI:1538312913
Name:TRITON HEALTHCARE
Entity Type:Organization
Organization Name:TRITON HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:337-962-2349
Mailing Address - Street 1:106 KILBOURNE CIR
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520-5348
Mailing Address - Country:US
Mailing Address - Phone:337-896-5885
Mailing Address - Fax:
Practice Address - Street 1:106 KILBOURNE CIR
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520-5348
Practice Address - Country:US
Practice Address - Phone:337-896-5885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00556311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home