Provider Demographics
NPI:1225449481
Name:TRIUMPHANT LIFE INTERVENTIONS
Entity Type:Organization
Organization Name:TRIUMPHANT LIFE INTERVENTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLENDONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-582-6129
Mailing Address - Street 1:5550 PAINTED MIRAGE RD STE 320
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4584
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5550 PAINTED MIRAGE RD STE 320
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4584
Practice Address - Country:US
Practice Address - Phone:702-582-6129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services