Provider Demographics
NPI:1598930463
Name:TRIANGLE ALLIED HEALTH
Entity Type:Organization
Organization Name:TRIANGLE ALLIED HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EZUMA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ASI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-605-6177
Mailing Address - Street 1:3537 MAITLAND DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1239
Mailing Address - Country:US
Mailing Address - Phone:919-250-1989
Mailing Address - Fax:
Practice Address - Street 1:3537 MAITLAND DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1239
Practice Address - Country:US
Practice Address - Phone:919-250-1989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-092-672251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCMHL-092-672OtherDHSR MH LICENSURE