MEDICARE: TRIUMPHANT LIFE CONNECTIONS 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	103K00000X	Behavior Analyst
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1790035038
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIUMPHANT LIFE CONNECTIONS LLC

Provider Business Mailing Address
First Line	:	10234 BEDROCK RIVER CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89178-6514
Country	:	US
Telephone Number	:	702-551-7700
Fax Number	:

Provider Business Practice Location Address
First Line	:	8565 S EASTERN AVE STE 150
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2906
Country	:	US
Telephone Number	:	702-551-7700
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. LINDA LAI
Credential	:
Telephone Number	:	702-551-7700

Provider Enumeration Date	:	09/13/2012
Last Update Date	:	03/07/2017

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