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Organization
TRIANGLE FAMILY MEDICAL SERVICES, INC.
Active
Organization
TRIANGLE FAMILY MEDICAL SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ELVENTRE' SHYTEL SOUTHERLAND (CEO)
(910) 978-9118
Entity
Organization
Contact information
Practice address
4005 FAYETTEVILLE RD, RAEFORD, NC 28376-8058
(910) 875-6806
Mailing address
4005 FAYETTEVILLE RD, RAEFORD, NC 28376-8058
(910) 875-6806
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251B00000X
Case Management Agency
—
—
251E00000X
Home Health Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
NC
252Y00000X
Early Intervention Provider Agency
—
—
261QA0600X
Adult Day Care Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
302F00000X
Exclusive Provider Organization
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
341600000X
Ambulance
—
—
Other
Enumeration date
08/29/2008
Last updated
08/29/2008
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