Provider Demographics
NPI:1558610832
Name:VICTORIA SUTTON
Entity Type:Organization
Organization Name:VICTORIA SUTTON
Other - Org Name:ACTIVE FAMILY HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-972-1709
Mailing Address - Street 1:14863 SORRENTO ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-3601
Mailing Address - Country:US
Mailing Address - Phone:847-972-1709
Mailing Address - Fax:
Practice Address - Street 1:14863 SORRENTO ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-3601
Practice Address - Country:US
Practice Address - Phone:847-972-1709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VICTORIA SUTTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-02
Last Update Date:2012-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization