Provider Demographics
NPI:1881902997
Name:TRIAD FAMILY SERVICES
Entity type:Organization
Organization Name:TRIAD FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MESSINA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:916-631-0771
Mailing Address - Street 1:14433 CATALINA ST
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-5515
Mailing Address - Country:US
Mailing Address - Phone:510-351-3665
Mailing Address - Fax:510-351-3906
Practice Address - Street 1:14433 CATALINA ST
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-5515
Practice Address - Country:US
Practice Address - Phone:510-351-3665
Practice Address - Fax:510-351-3906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA015202218253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency