Healthcare Provider Details

I. General information

NPI: 1336054782
Provider Name (Legal Business Name): TRIUMPHANT AFH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3007 CATALINA DR SE
LACEY WA
98503-3655
US

IV. Provider business mailing address

3007 CATALINA DR SE
LACEY WA
98503-3655
US

V. Phone/Fax

Practice location:
  • Phone: 360-999-1754
  • Fax: 350-999-1754
Mailing address:
  • Phone: 360-999-1754
  • Fax: 350-999-1754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MIRIAM NJERI GITAU
Title or Position: PROVIDER
Credential:
Phone: 360-999-1754