Provider Demographics
NPI:1639474760
Name:TRIAD CARE, INC.
Entity type:Organization
Organization Name:TRIAD CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:336-324-0942
Mailing Address - Street 1:306 POMONA DR STE F
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-1643
Mailing Address - Country:US
Mailing Address - Phone:336-541-6475
Mailing Address - Fax:336-541-6485
Practice Address - Street 1:306 POMONA DR STE F
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1643
Practice Address - Country:US
Practice Address - Phone:336-541-6475
Practice Address - Fax:336-541-6485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
NCL004018133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty