Organization
TRIUMPHANT LIFE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES FRANK PULLIAM PHD (CEO/PRESIDENT)
(760) 646-9174
Entity
Organization
Contact information
Practice address
19923 BEAR VALLEY RD, APPLE VALLEY, CA 92308-5106
(760) 553-5307
Mailing address
20851 PAMPUS LN, APPLE VALLEY, CA 92308-8616
(760) 646-9174
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
—
—
Other
Enumeration date
01/11/2016
Last updated
01/11/2016
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