Provider Demographics
NPI:1558600619
Name:VICTORIA HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:VICTORIA HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:O
Authorized Official - Last Name:OKELLO
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:901-606-6352
Mailing Address - Street 1:1951 CHARTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-2385
Mailing Address - Country:US
Mailing Address - Phone:901-606-6352
Mailing Address - Fax:
Practice Address - Street 1:1951 CHARTRIDGE DR
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-2385
Practice Address - Country:US
Practice Address - Phone:901-606-6352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-10
Last Update Date:2013-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities