Provider Demographics
NPI:1407564602
Name:TRIUMPH HEALTH & WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:TRIUMPH HEALTH & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LAVERNE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-402-3311
Mailing Address - Street 1:5600 HARFORD RD 1ST AND 2ND FLOORS
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-2266
Mailing Address - Country:US
Mailing Address - Phone:410-402-3311
Mailing Address - Fax:
Practice Address - Street 1:5600 HARFORD RD 1ST AND 2ND FLOORS
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-2266
Practice Address - Country:US
Practice Address - Phone:410-402-3311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-07
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder