Provider Demographics
NPI:1629108071
Name:TRIAD ADULT DAY CARE CENTER, INC.
Entity type:Organization
Organization Name:TRIAD ADULT DAY CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LASONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANEATON
Authorized Official - Suffix:
Authorized Official - Credentials:QP
Authorized Official - Phone:336-431-1537
Mailing Address - Street 1:409 E FAIRFIELD RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27263-2281
Mailing Address - Country:US
Mailing Address - Phone:336-431-1537
Mailing Address - Fax:336-431-8128
Practice Address - Street 1:409 E FAIRFIELD RD
Practice Address - Street 2:SUITE A
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27263-2281
Practice Address - Country:US
Practice Address - Phone:336-431-1537
Practice Address - Fax:336-431-8128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-041-813320900000X
NCMHL-041-987311ZA0620X, 320800000X, 3104A0625X
NCMHL-041-1084251S00000X, 261QD1600X, 261QA0600X, 251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No251S00000XAgenciesCommunity/Behavioral Health
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408665Medicaid