Provider Demographics
NPI:1558434126
Name:VICTOR COMMUNITY SUPPORT SERVICES, INC
Entity Type:Organization
Organization Name:VICTOR COMMUNITY SUPPORT SERVICES, INC
Other - Org Name:FAMILY INTERVENTION AND COMMUNITY SUPPORT
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:MADAUS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:530-671-3427
Mailing Address - Street 1:1952 HERSHEY DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95776-5143
Mailing Address - Country:US
Mailing Address - Phone:801-361-9943
Mailing Address - Fax:
Practice Address - Street 1:103 D ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-6017
Practice Address - Country:US
Practice Address - Phone:530-671-3427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20722251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health