Provider Demographics
NPI:1346813052
Name:VICTORY AFC INC
Entity Type:Organization
Organization Name:VICTORY AFC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANISHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-971-9333
Mailing Address - Street 1:3223 ROBERTS ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601-3137
Mailing Address - Country:US
Mailing Address - Phone:989-971-9333
Mailing Address - Fax:281-670-5667
Practice Address - Street 1:2525 MACKINAW ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-3143
Practice Address - Country:US
Practice Address - Phone:989-971-9333
Practice Address - Fax:281-670-5667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility