Provider Demographics
NPI:1407541626
Name:TRIUMPH HEALTHCARE LLC
Entity Type:Organization
Organization Name:TRIUMPH HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARCEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSTILLOS-PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-446-9906
Mailing Address - Street 1:30251 GOLDEN LANTERN STE E415
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-5993
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27272 DELEMOS
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-3246
Practice Address - Country:US
Practice Address - Phone:949-446-9973
Practice Address - Fax:209-297-4085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health