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Organization

TRIUMPH RESIDENTIAL, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. VERNON LAMONT TILLAGE JR. (CEO)
(757) 761-3921
Entity
Organization

Contact information

Practice address
3001 CHURCHLAND BLVD, CHESAPEAKE, VA 23321-5603
(757) 761-3921
Mailing address
3921 OLD FARM RD, PORTSMOUTH, VA 23703-2623
(757) 761-3921

Taxonomy

Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary

Other

Enumeration date
12/23/2019
Last updated
12/23/2019
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