MEDICARE: TRIUMPH HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1184255887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIUMPH HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	30251 GOLDEN LANTERN SUITE E-415
Second Line	:
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677
Country	:	US
Telephone Number	:	949-446-9906
Fax Number	:

Provider Business Practice Location Address
First Line	:	23201 ORANGE AVE
Second Line	:
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-4849
Country	:	US
Telephone Number	:	949-446-9906
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR / PROGRAM DIRECTOR
Name	:	MARCEE PATRICK
Credential	:
Telephone Number	:	800-575-9750

Provider Enumeration Date	:	01/31/2020
Last Update Date	:	08/09/2021

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