Provider Demographics
NPI:1528461449
Name:CASE MANAGEMENT CONNECTION OF THE TRIAD, INC.
Entity type:Organization
Organization Name:CASE MANAGEMENT CONNECTION OF THE TRIAD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHELIA
Authorized Official - Middle Name:H
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:336-803-5408
Mailing Address - Street 1:PO BOX 519
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27361-0519
Mailing Address - Country:US
Mailing Address - Phone:336-803-5408
Mailing Address - Fax:336-475-8170
Practice Address - Street 1:1897 SMITH FARM RD
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-7520
Practice Address - Country:US
Practice Address - Phone:336-803-5408
Practice Address - Fax:336-475-8170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC088569251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC088569Other163WC0400X