Provider Demographics
NPI:1013240407
Name:TRIUMPHANT LIVING CARE LLC
Entity Type:Organization
Organization Name:TRIUMPHANT LIVING CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-536-9037
Mailing Address - Street 1:2704 UPSHUR ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-1509
Mailing Address - Country:US
Mailing Address - Phone:202-536-9037
Mailing Address - Fax:240-667-1858
Practice Address - Street 1:2704 UPSHUR ST UNIT 2
Practice Address - Street 2:
Practice Address - City:MOUNT RAINIER
Practice Address - State:MD
Practice Address - Zip Code:20712-1509
Practice Address - Country:US
Practice Address - Phone:202-536-9037
Practice Address - Fax:240-667-1858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC332B00000X, 332BC3200X, 332BN1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies