Provider Demographics
NPI:1366646267
Name:LIVE THE VICTORY, INC.
Entity Type:Organization
Organization Name:LIVE THE VICTORY, INC.
Other - Org Name:THE MATTHEWS HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JERRI
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:HOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-472-0609
Mailing Address - Street 1:726 MATHEWS ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3313
Mailing Address - Country:US
Mailing Address - Phone:970-472-0609
Mailing Address - Fax:
Practice Address - Street 1:726 MATHEWS ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3313
Practice Address - Country:US
Practice Address - Phone:970-472-0609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty