Provider Demographics
NPI:1265698484
Name:TRIAD OUTREACH CENTER, INC.
Entity type:Organization
Organization Name:TRIAD OUTREACH CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MENEVA
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-884-8435
Mailing Address - Street 1:PO BOX 55
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-0055
Mailing Address - Country:US
Mailing Address - Phone:336-884-8435
Mailing Address - Fax:336-884-8462
Practice Address - Street 1:1314 LONG ST
Practice Address - Street 2:SUITE 107
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-2568
Practice Address - Country:US
Practice Address - Phone:336-884-8435
Practice Address - Fax:336-884-8462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health