| Triumph Llc | |
|
548 W Ridgeway St Warrenton NC 27589-1716 | |
| (252) 257-4071 | |
| Not Available |
| Full Name | Triumph Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 548 W Ridgeway St, Warrenton, North Carolina |
| Authorized Official Name and Position | Brenda Frazier (PROVIDER ENROLLMENT SPECIALIST) |
| Authorized Official Contact | 9192560824 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Triumph Llc 3210 Fairhill Dr Raleigh NC 27612-3220 Ph: (919) 256-0824 | Triumph Llc 548 W Ridgeway St Warrenton NC 27589-1716 Ph: (252) 257-4071 |
| NPI Number | 1689710840 |
|---|---|
| Provider Enumeration Date | 01/29/2007 |
| Last Update Date | 07/30/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689710840 | NPI | - | NPPES |
| 6005387 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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