Provider Demographics
NPI:1154756302
Name:TRIUMPHANT FAMILY SERVICES LLC
Entity type:Organization
Organization Name:TRIUMPHANT FAMILY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:QMHA
Authorized Official - Phone:702-771-0053
Mailing Address - Street 1:1516 E TROPICANA AVE
Mailing Address - Street 2:295-2
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6525
Mailing Address - Country:US
Mailing Address - Phone:702-771-0053
Mailing Address - Fax:
Practice Address - Street 1:1516 E TROPICANA AVE
Practice Address - Street 2:295-2
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6525
Practice Address - Country:US
Practice Address - Phone:702-771-0053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-06
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1780989699Medicaid