Provider Demographics
NPI:1376045104
Name:THERE IS VICTORY IN JESUS RECOVERY CENTER
Entity Type:Organization
Organization Name:THERE IS VICTORY IN JESUS RECOVERY CENTER
Other - Org Name:VICTORY IN JESUS RECOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:REV-UNITED METHODIST
Authorized Official - Phone:979-533-2319
Mailing Address - Street 1:218 NORTH HOUSTON STREET
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488
Mailing Address - Country:US
Mailing Address - Phone:979-532-2319
Mailing Address - Fax:979-532-2319
Practice Address - Street 1:218 NORTH HOUSTON STREET
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488
Practice Address - Country:US
Practice Address - Phone:979-532-2319
Practice Address - Fax:979-532-2319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 251V00000X
TX4253-4254324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No251V00000XAgenciesVoluntary or Charitable