Provider Demographics
NPI:1457840373
Name:VICTOR TREATMENT CENTERS, INC.
Entity Type:Organization
Organization Name:VICTOR TREATMENT CENTERS, INC.
Other - Org Name:VTC PASADENA
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OR FINANCIAL ANALYSIS
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:WIECHERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-230-1210
Mailing Address - Street 1:1360 E LASSEN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-7823
Mailing Address - Country:US
Mailing Address - Phone:530-893-0758
Mailing Address - Fax:530-893-0502
Practice Address - Street 1:36 S KINNELOA AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3853
Practice Address - Country:US
Practice Address - Phone:626-844-3033
Practice Address - Fax:626-844-3034
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VICTOR TREATMENT CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-07
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00118OtherLEGAL ENTITY NUMBER - MH