Active NPI
Triad Home Health LLC
- Home Health Agency
- Mangum, OK
National Provider Identifier
1083921795
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- License
- HC-7955
- Legal business name
- TRIAD HOME HEALTH LLC
- Practice address
- 129 N Pennsylvania Ave
Mangum, OK 73554-4221 - Phone
- (580) 782-5800
- Fax
- (580) 782-5803
- NPI assigned
- Sep 2, 2010
- Last updated
- Oct 18, 2019
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Bridget Lea Woodress, RN
- Title
- Ceo/Administrator
- Phone
- (580) 782-5800
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | HC-7955 | OK | Primary |
Addresses
Primary practice location
129 N Pennsylvania Ave
Mangum, OK 73554-4221
Mailing address
129 N Pennsylvania Ave
Mangum, OK 73554-4221
Phone (580) 782-5800
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OK
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101104001281 | OK | Part A Provider - Home Health Agency | 2567656366 | Practice locations: Mangum, OK |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1083921795. Details of each certification follow.
Home health agency certification: CCN 377747
- Legal name
- TRIAD HOME HEALTH LLC
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Apr 8, 2011
- Last certification
- Jan 30, 2020
- Ownership / control type
- Proprietary
- Organization structure
- LLC
- Incorporated
- Jan 27, 2010 in OK
- Enrollment address
- 129 North Pennsylvania
Mangum, OK 73554-2500
Care Compare: Home health agency
Medicare Care Compare- Listed as
- Triad Home Health LLC
- Overall star rating
- Ownership
- Proprietary
- Certified
- Apr 8, 2011
- Medicare certification status
- Active
- Services
- Nursing, Home health aide, Physical therapy, Speech pathology, Occupational therapy
National Provider Directory
National Provider DirectoryLocations
129 N Pennsylvania Ave
Mangum, OK 73554
Phone (580) 782-3317
Ownership & related parties
All disclosed owners & managing parties 2
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Bridget Woodress | 5% Or Greater Direct Ownership Interest | Nov 22, 2016 | 100% |
| Corporate Officer | Nov 22, 2016 | 100% | |
| Corporate Director | Nov 22, 2016 | 100% | |
| W-2 Managing Employee | Nov 22, 2016 | 100% | |
| Operational/Managerial Control | Nov 22, 2016 | 100% | |
| Triad Home Health LLC | Operational/Managerial Control | Nov 22, 2016 | 100% |
Practitioners & affiliated clinicians
Affiliated clinicians 13
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Family Nurse Practitioner
- Mangum, OK
- NPI 1831652007
Home health agency
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1283385600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1571356800000",
"number": "1083921795",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "129 N PENNSYLVANIA AVE",
"city": "MANGUM",
"state": "OK",
"postal_code": "735544221",
"telephone_number": "580-782-5800",
"fax_number": "580-782-5803"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "129 N PENNSYLVANIA AVE",
"city": "MANGUM",
"state": "OK",
"postal_code": "735544221",
"telephone_number": "580-782-5800",
"fax_number": "580-782-5803"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TRIAD HOME HEALTH LLC",
"organizational_subpart": "NO",
"enumeration_date": "2010-09-02",
"last_updated": "2019-10-18",
"status": "A",
"authorized_official_last_name": "WOODRESS",
"authorized_official_first_name": "BRIDGET",
"authorized_official_middle_name": "LEA",
"authorized_official_title_or_position": "CEO/ADMINISTRATOR",
"authorized_official_telephone_number": "580-782-5800",
"authorized_official_name_prefix": "Mrs.",
"authorized_official_credential": "RN"
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": "OK",
"license": "HC-7955",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mangum, OK
- Ashley Brooke Slaton, APRN-CNP
- Christian Smith
- Shelly Smith
- Frank M Talley, M.ED L.A.DC
- TLC of Chiropractic L.L.C. (The Locklear Clinic of Chiropractic)
- Lexie Noel Turner
- United Pharmacy of Mangum LLC (United Pharmacy of Mangum)
- Kathren Leigh Webb, APRN-CNP
- Yco Tulsa, Inc (YouthCare of Oklahoma)
- Yco Tulsa, Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.