Provider Demographics
NPI:1083465363
Name:TRIUMPH CLINICAL SERVICES
Entity Type:Organization
Organization Name:TRIUMPH CLINICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-608-9094
Mailing Address - Street 1:300 WASHINGTON ST STE 104
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-6751
Mailing Address - Country:US
Mailing Address - Phone:318-608-9094
Mailing Address - Fax:
Practice Address - Street 1:300 WASHINGTON ST STE 104
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6751
Practice Address - Country:US
Practice Address - Phone:318-608-9094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility