Provider Demographics
NPI:1679861413
Name:VICTORY HUMAN SERVICES
Entity Type:Organization
Organization Name:VICTORY HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:SENESIE
Authorized Official - Suffix:
Authorized Official - Credentials:EDM
Authorized Official - Phone:617-474-9699
Mailing Address - Street 1:461 WASHINGTON ST
Mailing Address - Street 2:PO BOX 240934
Mailing Address - City:DORCHESTER CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-2039
Mailing Address - Country:US
Mailing Address - Phone:617-474-9699
Mailing Address - Fax:
Practice Address - Street 1:461 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER CENTER
Practice Address - State:MA
Practice Address - Zip Code:02124-2039
Practice Address - Country:US
Practice Address - Phone:617-474-9699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAVC6000189457320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA09041956Medicaid
MA09041956Medicaid