VICTORY RESIDENTIAL CORPORATION NPI 1396420469

NPI Information

NPI: 1396420469
Provider Name: VICTORY RESIDENTIAL CORPORATION
Classification: Substance Abuse Rehabilitation Facility - 324500000X
Entity Type: Organization
Address:
1566 E JEANNE LN
SAN TAN VALLEY, AZ
ZIP 85140
Phone: (612) 636-3194
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VICTORY RESIDENTIAL CORPORATION is a substance abuse rehabilitation facility in San Tan Valley, AZ. The provider is a facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. VICTORY RESIDENTIAL CORPORATION NPI is 1396420469. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1566 E JEANNE LN
SAN TAN VALLEY, AZ
ZIP 85140-046
Phone: (612) 636-3194

The provider's authorized official is Xavier Alexander Davis .
The authorized official title is Owner / Ceo and has the following contact phone number (612) 636-3194.

The enumeration date for this NPI number is 6/16/2023 and was last updated on 6/19/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)			No
2	324500000X	Substance Abuse Rehabilitation Facility				Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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