Provider Demographics
NPI:1437293842
Name:VICTORY FOR LIFE
Entity Type:Organization
Organization Name:VICTORY FOR LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMYTH
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:859-527-7671
Mailing Address - Street 1:PO BOX 2047
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40476-2047
Mailing Address - Country:US
Mailing Address - Phone:859-527-7671
Mailing Address - Fax:
Practice Address - Street 1:225 E PRONG RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-8917
Practice Address - Country:US
Practice Address - Phone:859-527-7671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management