Organization Name: | TRIUMPH LLC |
NPI Number: | 1003961269 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TALESHA ROLLOCK (PROVIDER ENROLLMENT SPECIALIST) |
Mailing Address: | 5505 Creedmoor Rd Suite 100 Raleigh |
State: | NC US |
Postal Code: | 276126333 |
Phone Number: | 9198525352 |
Fax Number: | 9198525323 |
NPI Enumeration Date: | 01/25/2007 |
NPI Last Update Date: | 04/23/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |