Provider Demographics
NPI:1275301822
Name:VICTORY'S VILLAGE, LLC
Entity Type:Organization
Organization Name:VICTORY'S VILLAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:TUAZON
Authorized Official - Last Name:GATCHALIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-980-7609
Mailing Address - Street 1:4588 S PLAZA TRL STE 105
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-7792
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4588 S PLAZA TRL STE 105
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-7792
Practice Address - Country:US
Practice Address - Phone:757-231-5135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health