Provider Demographics
NPI:1326506510
Name:THE VICTORIAN CENTER, LLC
Entity Type:Organization
Organization Name:THE VICTORIAN CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:F
Authorized Official - Last Name:ANTONIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-595-2268
Mailing Address - Street 1:11 WHITEWIND LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-5233
Mailing Address - Country:US
Mailing Address - Phone:702-459-2567
Mailing Address - Fax:702-982-6096
Practice Address - Street 1:1895 PRISCILLA ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89156-7118
Practice Address - Country:US
Practice Address - Phone:702-595-2268
Practice Address - Fax:702-982-6096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility