Provider Demographics
NPI:1376933051
Name:TRIUMPH RESIDENTIAL SERVICES, LLC
Entity Type:Organization
Organization Name:TRIUMPH RESIDENTIAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LASHANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-520-0100
Mailing Address - Street 1:16067 CONTINENTAL BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23834-5900
Mailing Address - Country:US
Mailing Address - Phone:804-520-0100
Mailing Address - Fax:
Practice Address - Street 1:16067 CONTINENTAL BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23834-5900
Practice Address - Country:US
Practice Address - Phone:804-520-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRIUMPH RESIDENTIAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA927-02-006251C00000X
VA927-02-001320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services