Provider Demographics
NPI:1922822071
Name:VICTORIA MEADOWS LLC
Entity type:Organization
Organization Name:VICTORIA MEADOWS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:COLE
Authorized Official - Last Name:MCGOWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-590-0440
Mailing Address - Street 1:2660 NE HIGHWAY 20 STE 610-365
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6402
Mailing Address - Country:US
Mailing Address - Phone:541-433-2435
Mailing Address - Fax:
Practice Address - Street 1:140908 ELK HAVEN WAY
Practice Address - Street 2:
Practice Address - City:CRESCENT LAKE
Practice Address - State:OR
Practice Address - Zip Code:97733-7069
Practice Address - Country:US
Practice Address - Phone:541-433-2435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility