Provider Demographics
NPI:1093163230
Name:TRIUMPH RECOVERY, INC.
Entity Type:Organization
Organization Name:TRIUMPH RECOVERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-339-8941
Mailing Address - Street 1:1953 SAN ELIJO AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:CARDIFF BY THE SEA
Mailing Address - State:CA
Mailing Address - Zip Code:92007-2348
Mailing Address - Country:US
Mailing Address - Phone:302-636-5401
Mailing Address - Fax:818-736-9893
Practice Address - Street 1:13252 MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-1531
Practice Address - Country:US
Practice Address - Phone:818-736-9891
Practice Address - Fax:818-736-9893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility