Provider Demographics
NPI:1821179797
Name:VICTOR & ASSOCIATES, INC.
Entity Type:Organization
Organization Name:VICTOR & ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SONNY
Authorized Official - Middle Name:S
Authorized Official - Last Name:PERSAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-718-4988
Mailing Address - Street 1:PO BOX 261
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:NC
Mailing Address - Zip Code:28326-0261
Mailing Address - Country:US
Mailing Address - Phone:919-718-4988
Mailing Address - Fax:191-718-4990
Practice Address - Street 1:1600 S THIRD STREET
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4201
Practice Address - Country:US
Practice Address - Phone:919-718-4988
Practice Address - Fax:191-718-4990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-043-048320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408979Medicaid
NC7805414Medicaid
NC8301169Medicaid
NC7804832Medicaid