Provider Demographics
NPI:1043314792
Name:TRIUMPH, LLC
Entity Type:Organization
Organization Name:TRIUMPH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-467-2433
Mailing Address - Street 1:2101 GATEWAY CENTRE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-6214
Mailing Address - Country:US
Mailing Address - Phone:919-467-2433
Mailing Address - Fax:919-467-4903
Practice Address - Street 1:118 PEACE ST
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-4519
Practice Address - Country:US
Practice Address - Phone:336-667-1440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005574Medicaid