Provider Demographics
NPI:1598912164
Name:TRIAD HEALTHCARE, INC.
Entity Type:Organization
Organization Name:TRIAD HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AGOSTINO
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:VILLANI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-793-3302
Mailing Address - Street 1:80 SPRING LN
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-1151
Mailing Address - Country:US
Mailing Address - Phone:800-550-0540
Mailing Address - Fax:860-793-3316
Practice Address - Street 1:80 SPRING LN
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-1151
Practice Address - Country:US
Practice Address - Phone:800-550-0540
Practice Address - Fax:860-793-3316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000000001305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization