Provider Demographics
NPI:1912098377
Name:INTERIM HEALTHCARE OF THE TRIANGLE, LLC
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE OF THE TRIANGLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-420-0336
Mailing Address - Street 1:6310 CHAPEL HILL RD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-4242
Mailing Address - Country:US
Mailing Address - Phone:919-420-0336
Mailing Address - Fax:919-420-0172
Practice Address - Street 1:6310 CHAPEL HILL RD
Practice Address - Street 2:SUITE 280
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-4242
Practice Address - Country:US
Practice Address - Phone:919-420-0336
Practice Address - Fax:919-420-0172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2074251E00000X, 251F00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601783Medicaid