Provider Demographics
NPI:1548592215
Name:VICTORY RESIDENTIAL SERVICES LLC
Entity Type:Organization
Organization Name:VICTORY RESIDENTIAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ISAREL
Authorized Official - Middle Name:UDOCHUKWU
Authorized Official - Last Name:OJIMADU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-247-8391
Mailing Address - Street 1:7048 KNIGHTDALE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-8894
Mailing Address - Country:US
Mailing Address - Phone:919-247-8391
Mailing Address - Fax:
Practice Address - Street 1:9200 SAYORNIS CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-8114
Practice Address - Country:US
Practice Address - Phone:919-247-8391
Practice Address - Fax:919-266-3809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-05
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities