Provider Demographics
NPI:1790376978
Name:TRIAD GERIATRIC CARE LLC
Entity Type:Organization
Organization Name:TRIAD GERIATRIC CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY OWNER/ CNA
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:AZAKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-687-9705
Mailing Address - Street 1:259 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27295-7110
Mailing Address - Country:US
Mailing Address - Phone:336-687-9705
Mailing Address - Fax:
Practice Address - Street 1:615 SAINT GEORGE SQUARE CT STE 343
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1368
Practice Address - Country:US
Practice Address - Phone:336-687-9705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-29
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health