Provider Demographics
NPI:1093187171
Name:VICTOR J WHITTIER SR LLC
Entity Type:Organization
Organization Name:VICTOR J WHITTIER SR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:WHITTIER
Authorized Official - Suffix:SR
Authorized Official - Credentials:AS, BS, MSCJ, RASAC
Authorized Official - Phone:314-580-9907
Mailing Address - Street 1:1108 COVE LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63138-3047
Mailing Address - Country:US
Mailing Address - Phone:314-580-9907
Mailing Address - Fax:
Practice Address - Street 1:1108 COVE LN
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63138-3047
Practice Address - Country:US
Practice Address - Phone:314-580-9907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPECIAL ATTENTION INTERVENTION NEEDS & TRANSPORTATION SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251B00000X, 251C00000X, 251S00000X, 253Z00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care