Provider Demographics
NPI:1912770520
Name:TRIUMPH LIVING LLC
Entity Type:Organization
Organization Name:TRIUMPH LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:STANTON
Authorized Official - Last Name:COSPER
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:330-507-2988
Mailing Address - Street 1:1368 CHICKWEED ST
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-8333
Mailing Address - Country:US
Mailing Address - Phone:330-507-2988
Mailing Address - Fax:
Practice Address - Street 1:3350 ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-1388
Practice Address - Country:US
Practice Address - Phone:330-507-2988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty