# ICE20 - TRIAD SPORTS GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** TRIAD SPORTS GROUP, LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1285964932
- **Legal business name:** TRIAD SPORTS GROUP, LLC
- **Authorized official:** BRAD L SMITH (DIVISION PRESIDENT)
- **Authorized official phone:** (805) 857-4172

## Contact information

- **Practice address:** 4690 CALLE QUETZAL, CAMARILLO, CA 93012-8558
- **Practice address phone:** (805) 857-4172
- **Mailing address:** 4690 CALLE QUETZAL, CAMARILLO, CA 93012-8558
- **Mailing address phone:** (805) 857-4172

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |

## Other

- **Enumeration date:** 12/31/2009
- **Last updated:** 10/07/2014