Provider Demographics
NPI:1154591386
Name:TRIUMPH, LLC
Entity type:Organization
Organization Name:TRIUMPH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MGR./OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:E
Authorized Official - Last Name:JONES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:919-256-0824
Mailing Address - Street 1:3210 FAIRHILL DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-3215
Mailing Address - Country:US
Mailing Address - Phone:919-256-0824
Mailing Address - Fax:919-256-0833
Practice Address - Street 1:3708 MAYFAIR ST
Practice Address - Street 2:SOUTH SQUARE 2
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6226
Practice Address - Country:US
Practice Address - Phone:919-683-1800
Practice Address - Fax:919-489-7108
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRIUMPH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-04
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YP2500X, 103T00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6006415Medicaid
NC6006415Medicaid
NC2335621BMedicare PIN
NC2335621Medicare PIN