Provider Demographics
NPI:1740221464
Name:TRIAD HOME CARE INC
Entity Type:Organization
Organization Name:TRIAD HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SANTANU
Authorized Official - Middle Name:K
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:OCCUPATIONAL THERAPI
Authorized Official - Phone:734-266-3500
Mailing Address - Street 1:28482 CHERRY HILL RD STE C
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-4704
Mailing Address - Country:US
Mailing Address - Phone:734-266-3500
Mailing Address - Fax:734-266-3501
Practice Address - Street 1:28482 CHERRY HILL RD STE C
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-4704
Practice Address - Country:US
Practice Address - Phone:734-266-3500
Practice Address - Fax:734-266-3501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI237556Medicare ID - Type Unspecified