Victory Residential Corporation | |
1566 E Jeanne Ln San Tan Valley AZ 85140-4046 | |
(612) 636-3194 | |
Not Available |
Full Name | Victory Residential Corporation |
---|---|
Speciality | Substance Abuse Rehabilitation Facility |
Location | 1566 E Jeanne Ln, San Tan Valley, Arizona |
Authorized Official Name and Position | Xavier Alexander Davis (OWNER / CEO) |
Authorized Official Contact | 6126363194 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Victory Residential Corporation 1566 E Jeanne Ln San Tan Valley AZ 85140-4046 Ph: (612) 636-3194 | Victory Residential Corporation 1566 E Jeanne Ln San Tan Valley AZ 85140-4046 Ph: (612) 636-3194 |
NPI Number | 1396420469 |
---|---|
Provider Enumeration Date | 06/16/2023 |
Last Update Date | 06/19/2023 |
Certification Date | 06/19/2023 |
Identifier | Type | State | Issuer |
---|---|---|---|
1396420469 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
324500000X | Substance Abuse Rehabilitation Facility | (* (Not Available)) | Primary |
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