Organization
TRIANGLE ALLIED HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EZUMA E ASI (DIRECTOR)
(919) 605-6177
Entity
Organization
Contact information
Practice address
3537 MAITLAND DR, RALEIGH, NC 27610-1239
(919) 250-1989
Mailing address
3537 MAITLAND DR, RALEIGH, NC 27610-1239
(919) 250-1989
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
MHL-092-672
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MHL-092-672
DHSR MH LICENSURE
NC
Enumeration date
04/23/2008
Last updated
04/23/2008
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