Provider Demographics
NPI:1366028102
Name:VICTORY BEHAVIORAL HEALTHCARE PLLC
Entity Type:Organization
Organization Name:VICTORY BEHAVIORAL HEALTHCARE PLLC
Other - Org Name:VICTORY BEHAVIORAL HEALTH RESIDENTIAL FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:EZINNE
Authorized Official - Middle Name:
Authorized Official - Last Name:IROKU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-877-8107
Mailing Address - Street 1:8017 W ALBENIZ PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85043-1698
Mailing Address - Country:US
Mailing Address - Phone:602-877-8107
Mailing Address - Fax:
Practice Address - Street 1:8017 W ALBENIZ PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85043-1698
Practice Address - Country:US
Practice Address - Phone:602-877-8107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-22
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children