Provider Demographics
NPI:1841729993
Name:TRIAD HOME CARE
Entity type:Organization
Organization Name:TRIAD HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:S
Authorized Official - Last Name:KOROMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-908-1832
Mailing Address - Street 1:900 MEADOWOOD ST # A
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27409-2820
Mailing Address - Country:US
Mailing Address - Phone:336-908-1832
Mailing Address - Fax:
Practice Address - Street 1:900 MEADOWOOD ST # A
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409-2820
Practice Address - Country:US
Practice Address - Phone:336-908-1832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care