Provider Demographics
NPI:1427263250
Name:TRIAD HEALTHCARE
Entity type:Organization
Organization Name:TRIAD HEALTHCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVINSOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-981-7111
Mailing Address - Street 1:PO BOX 92770
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90009-2770
Mailing Address - Country:US
Mailing Address - Phone:818-501-0434
Mailing Address - Fax:818-501-6430
Practice Address - Street 1:4929 VAN NUYS BL
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403
Practice Address - Country:US
Practice Address - Phone:818-501-0434
Practice Address - Fax:818-501-6430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP40114HMedicaid
CAHSP30114HMedicaid
CAHSC30114HMedicaid
CAHSC30114HMedicaid