Triad Telecare, Inc.

Primary specialty

Lodging ProviderTaxonomy code 177F00000X

License

HAL076008 Issued in NC

Legal business name

TRIAD TELECARE, INC.

Doing business as

Country Club Rest Home

Practice address

1324 Coltrane Mill Rd
Randleman, NC 27317-8020

Phone

(336) 574-6293

NPI assigned

Feb 6, 2007

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

Ms. Pearlie M. Bullock

Title

Administrator

Phone

(336) 674-6293

Specialties & licenses 1

Addresses

Other names 1

• Country Club Rest Home Doing business as

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1790825354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1328 COLTRANE MILL RD",
            "city": "RANDLEMAN",
            "state": "NC",
            "postal_code": "273178020",
            "telephone_number": "336-674-6293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1324 COLTRANE MILL RD",
            "city": "RANDLEMAN",
            "state": "NC",
            "postal_code": "273178020",
            "telephone_number": "336-574-6293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIAD TELECARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BULLOCK",
        "authorized_official_first_name": "PEARLIE",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "336-674-6293",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "177F00000X",
            "taxonomy_group": "",
            "desc": "Lodging",
            "state": "NC",
            "license": "HAL076008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Country Club Rest Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Lodging Provider in Randleman, NC
• Providers in Randleman, NC by specialty
• Lodging Provider in North Carolina

• 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.