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General NPI Number Information
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NPI Number | 1912770520
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Entity Type | Organization
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Legal Business Name | TRIUMPH LIVING LLC
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Dates
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Enumeration Date | 11/06/2023
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Last Update Date | 11/06/2023
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Provider Practice Location Address
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Address Line | 3350 ALLEGHENY AVE
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City | COLUMBUS
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State | OH
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Zip | 43209-1388
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Country | US
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Telephone | 330-507-2988
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Fax |
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Provider Business Mailing Address
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Address Line | 1368 CHICKWEED ST
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City | BLACKLICK
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State | OH
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Zip | 43004-8333
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Country | US
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Telephone | 330-507-2988
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARCUS STANTON COSPER
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Credential | PA
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Telephone | 330-507-2988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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