MEDICARE: TRIUMPHANT HOME CARE 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1255055190
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIUMPHANT HOME CARE LLC

Provider Business Mailing Address
First Line	:	604 WASHINGTON COVE WAY
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46229-3922
Country	:	US
Telephone Number	:	317-416-1038
Fax Number	:

Provider Business Practice Location Address
First Line	:	1715 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-2733
Country	:	US
Telephone Number	:	317-416-1038
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LATOYA BROWN
Credential	:
Telephone Number	:	317-416-1038

Provider Enumeration Date	:	10/03/2022
Last Update Date	:	11/19/2024

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