Provider Demographics
NPI:1013490366
Name:THE VICTORIAN CENTER, LLC
Entity Type:Organization
Organization Name:THE VICTORIAN CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:FE
Authorized Official - Last Name:ANTONIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-459-2567
Mailing Address - Street 1:11 WHITEWIND LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-5233
Mailing Address - Country:US
Mailing Address - Phone:702-459-2567
Mailing Address - Fax:702-982-6096
Practice Address - Street 1:11 WHITEWIND LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-5233
Practice Address - Country:US
Practice Address - Phone:702-459-2567
Practice Address - Fax:702-982-6096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility