Provider Demographics
NPI:1770006496
Name:VICTORIOUS LLC
Entity Type:Organization
Organization Name:VICTORIOUS LLC
Other - Org Name:VICTORIOUS BEHAVIORAL HEALTH SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:UKANWOKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-723-0125
Mailing Address - Street 1:2225 E FLAMINGO RD STE 204
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2225 E FLAMINGO RD STE 204
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5127
Practice Address - Country:US
Practice Address - Phone:702-723-0125
Practice Address - Fax:702-323-0898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1518510288OtherNPPES