Provider Demographics
NPI:1770672602
Name:TRIAD FAMILY SERVICES
Entity Type:Organization
Organization Name:TRIAD FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-914-7279
Mailing Address - Street 1:2445 ALBATROSS WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-2878
Mailing Address - Country:US
Mailing Address - Phone:916-631-0771
Mailing Address - Fax:916-631-0498
Practice Address - Street 1:2445 ALBATROSS WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-2878
Practice Address - Country:US
Practice Address - Phone:916-631-0771
Practice Address - Fax:916-631-0498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0000034CTOtherMEDI-CAL PROVIDER NUMBER