# TRIUMPHANT LIFE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982060695
- **Authorized official:** DR. CHARLES FRANK PULLIAM PHD (CEO/PRESIDENT)
- **Authorized official phone:** (760) 646-9174

## Contact information

- **Practice address:** 19923 BEAR VALLEY RD, APPLE VALLEY, CA 92308-5106
- **Practice address phone:** (760) 553-5307
- **Mailing address:** 20851 PAMPUS LN, APPLE VALLEY, CA 92308-8616
- **Mailing address phone:** (760) 646-9174

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0401X | Comprehensive Outpatient Rehabilitation Facility (CORF) | — | NULL | Yes |

## Other

- **Enumeration date:** 01/11/2016
- **Last updated:** 01/11/2016