Provider Demographics
NPI:1982925780
Name:TRIUMPH ACADEMY INC
Entity Type:Organization
Organization Name:TRIUMPH ACADEMY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANI
Authorized Official - Middle Name:
Authorized Official - Last Name:LOTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-589-4457
Mailing Address - Street 1:62 S 950 W
Mailing Address - Street 2:P.O. BOX 432
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-4424
Mailing Address - Country:US
Mailing Address - Phone:801-589-4457
Mailing Address - Fax:435-538-5066
Practice Address - Street 1:62 S 950 W
Practice Address - Street 2:
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-4424
Practice Address - Country:US
Practice Address - Phone:801-589-4457
Practice Address - Fax:435-538-5066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTPENDING322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children