Basic Information
| Provider Information | |||||||||
| NPI: | 1376721886 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRIANGLE LIFELINE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 15279 | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277040279 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194796050 | ||||||||
| FaxNumber: | 9194775474 | ||||||||
| Practice Location | |||||||||
| Address1: | 3414 N DUKE ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277042131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194796050 | ||||||||
| FaxNumber: | 9194775474 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2008 | ||||||||
| LastUpdateDate: | 02/06/2008 | ||||||||
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| AuthorizedOfficialLastName: | WRAY | ||||||||
| AuthorizedOfficialFirstName: | STEVE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9194796050 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 333300000X | Y | Suppliers | Emergency Response System Companies |
ID Information
| ID | Type | State | Issuer | Description | 3409606 | 05 | NC | MEDICAID |