1295934198 NPI number — TRIANGLE LIFELINE

Table of content: (NPI 1295934198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295934198 NPI number — TRIANGLE LIFELINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRIANGLE LIFELINE
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:
Provider Other Organization Name Type Code:
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:
1295934198
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 15279
Provider Second Line Business Mailing Address:
3414 N. DUKE ST. SUITE 400
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27704-0279
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-479-6050
Provider Business Mailing Address Fax Number:
919-477-5474

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3414 N DUKE ST
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27704-2131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-479-6050
Provider Business Practice Location Address Fax Number:
919-477-5474
Provider Enumeration Date:
07/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WRAY
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
WARD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
91947960550

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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