Provider Demographics
NPI:1871249920
Name:VICTORY HEALTH CARE SERVICES 1 LLC
Entity Type:Organization
Organization Name:VICTORY HEALTH CARE SERVICES 1 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ABIOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLORUNTOBA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:404-791-3060
Mailing Address - Street 1:1755 THE EXCHANGE SE STE 265
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-7431
Mailing Address - Country:US
Mailing Address - Phone:404-791-3060
Mailing Address - Fax:
Practice Address - Street 1:1755 THE EXCHANGE
Practice Address - Street 2:STE 265
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2037
Practice Address - Country:US
Practice Address - Phone:404-791-3060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-28
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder