1073840369 NPI number — CTC TRIAD, INC.

Table of content: (NPI 1073840369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073840369 NPI number — CTC TRIAD, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CTC TRIAD, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SILVER LINING TRANSPORT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073840369
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1275 FAIRFAX AVE STE 203A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94124-1759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-777-2237
Provider Business Mailing Address Fax Number:
415-777-2259

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1805 TRIBUTE RD STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95815-4303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-333-5733
Provider Business Practice Location Address Fax Number:
916-333-5797
Provider Enumeration Date:
11/09/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NARIUNANONT
Authorized Official First Name:
CHANCHIRA
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
415-777-2237

Provider Taxonomy Codes

  • Taxonomy code: 343900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)