Provider Demographics
NPI:1598863284
Name:TRIAD HEALTH PROJECT
Entity Type:Organization
Organization Name:TRIAD HEALTH PROJECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VIRGINA
Authorized Official - Middle Name:ADDISON
Authorized Official - Last Name:ORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-275-1654
Mailing Address - Street 1:PO BOX 5716
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27435-0716
Mailing Address - Country:US
Mailing Address - Phone:336-275-1654
Mailing Address - Fax:336-275-2209
Practice Address - Street 1:801 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-7856
Practice Address - Country:US
Practice Address - Phone:336-275-1654
Practice Address - Fax:336-275-2209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8700202Medicaid