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
1	251S00000X	Community/Behavioral Health Agency	MLH-092-668	NC

Other Identifiers

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

General Provider Information

NPI Number	:	1811176076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIUMPH, LLC

Provider Business Mailing Address
First Line	:	3210 FAIRHILL DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-3215
Country	:	US
Telephone Number	:	919-256-0824
Fax Number	:	919-256-0833

Provider Business Practice Location Address
First Line	:	2209 CENTURY DR
Second Line	:	SUITE 101
City	:	RALEIGH
State	:	NC
Zip	:	27612-3941
Country	:	US
Telephone Number	:	919-786-4944
Fax Number	:	919-786-4945

Authorized Official
Title or Position	:	PROVIDER ENROLLMENT SPECIALIST
Name	:	BRENDA FRAZIER
Credential	:
Telephone Number	:	919-256-0824

Provider Enumeration Date	:	10/24/2007
Last Update Date	:	03/11/2008

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Directions to “TRIUMPH, LLC ” Practice Location

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