Provider Demographics
NPI:1073700332
Name:VICTORY CENTRE OF RIVER OAKS LLC
Entity Type:Organization
Organization Name:VICTORY CENTRE OF RIVER OAKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RISK MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BECHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-837-0710
Mailing Address - Street 1:30 S WACKER DR STE 1010
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-7413
Mailing Address - Country:US
Mailing Address - Phone:312-837-0701
Mailing Address - Fax:312-837-0728
Practice Address - Street 1:1370 RING ROAD
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-5428
Practice Address - Country:US
Practice Address - Phone:708-730-0994
Practice Address - Fax:708-730-1078
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATHWAY MANAGEMENT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-01
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
310400000X
IL310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364336170001Medicaid