Triad Residential Solutions LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

2293414 Issued in OH

Legal business name

TRIAD RESIDENTIAL SOLUTIONS LLC

Practice address

4986 Gateway Dr
Medina, OH 44256

Phone

(330) 723-7980

Fax

(330) 723-7981

NPI assigned

Sep 11, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Todd J Frick

Title

Director

Phone

(419) 536-3497

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1417051541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 352313",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436352313",
            "telephone_number": "419-536-3497",
            "fax_number": "419-536-3529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4986 GATEWAY DR",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "44256",
            "telephone_number": "330-723-7980",
            "fax_number": "330-723-7981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIAD RESIDENTIAL SOLUTIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FRICK",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "419-536-3497",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "OH",
            "license": "2293414",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4800899",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Medina, OH
• Providers in Medina, OH by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.