Provider Demographics
NPI:1518751452
Name:ITRIUMPH HEALTHCARE LLC
Entity type:Organization
Organization Name:ITRIUMPH HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCISCA
Authorized Official - Middle Name:
Authorized Official - Last Name:OGBONNA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:678-414-9162
Mailing Address - Street 1:2668 WOLF LAKE DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-1299
Mailing Address - Country:US
Mailing Address - Phone:678-414-9162
Mailing Address - Fax:
Practice Address - Street 1:2668 WOLF LAKE DR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-1299
Practice Address - Country:US
Practice Address - Phone:678-414-9162
Practice Address - Fax:000-000-0000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty