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

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841336021
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	:	4000 WAKE FOREST RD
Second Line	:	SUITE 200
City	:	RALEIGH
State	:	NC
Zip	:	27609-6879
Country	:	US
Telephone Number	:	919-852-5352
Fax Number	:	919-852-5323

Authorized Official
Title or Position	:	MEMBER MGR
Name	:	HAROLD E JONES JR.
Credential	:
Telephone Number	:	919-256-0824

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	09/28/2012

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Directions to “TRIUMPH LLC ” Practice Location

Language	Start Address	Practice Location

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