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NPI Code Detail

MEDICARE: TRIUMPH LLC

MEDICARE: TRIUMPH 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
1101YP2500XProfessional Counselor
2103T00000XPsychologist
31041C0700XClinical Social Worker
4106H00000XMarriage & Family Therapist
52084P0800XPsychiatry Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1316008410
Entity Type Code : Organization
Provider Name (Legal Business Name) : TRIUMPH LLC
Provider Business Mailing Address
First Line : 189 SAMARITAN RIDGE ROAD
Second Line :
City : ELKIN
State : NC
Zip : 28621-2452
Country : US
Telephone Number : 336-526-8335
Fax Number :
Provider Business Practice Location Address
First Line : 189 SAMARITAN RIDGE ROAD
Second Line :
City : ELKIN
State : NC
Zip : 28621-2452
Country : US
Telephone Number : 336-526-8335
Fax Number :
Authorized Official
Title or Position : MBR MGR
Name : HAROLD JONES
Credential :
Telephone Number : 919-256-0824
Provider Enumeration Date : 12/12/2006
Last Update Date : 09/11/2025

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Practice Fax:

Directions to “TRIUMPH LLC ” Practice Location

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