Provider Demographics
NPI:1245698489
Name:MIH VICTORY INC
Entity type:Organization
Organization Name:MIH VICTORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERCILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-256-0725
Mailing Address - Street 1:311 AUDUBON AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-4237
Mailing Address - Country:US
Mailing Address - Phone:212-256-0725
Mailing Address - Fax:917-261-4704
Practice Address - Street 1:311 AUDUBON AVE FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-4237
Practice Address - Country:US
Practice Address - Phone:212-256-0725
Practice Address - Fax:917-261-4704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170111976101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY170111976OtherOFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES