Provider Demographics
NPI:1215405626
Name:VICTORY MANAGEMENT FAMILY HOMES
Entity Type:Organization
Organization Name:VICTORY MANAGEMENT FAMILY HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-632-2560
Mailing Address - Street 1:21246 WESTVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-2268
Mailing Address - Country:US
Mailing Address - Phone:248-632-2560
Mailing Address - Fax:
Practice Address - Street 1:21246 WESTVIEW AVE
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-2268
Practice Address - Country:US
Practice Address - Phone:248-632-2560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253J00000XAgenciesFoster Care Agency
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility