Provider Demographics
NPI:1457051419
Name:LIGHT OF VICTORY ASSISTED LIVING
Entity Type:Organization
Organization Name:LIGHT OF VICTORY ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:C
Authorized Official - Last Name:ORJI
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:909-461-0040
Mailing Address - Street 1:6700 E 129TH AVE
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-4678
Mailing Address - Country:US
Mailing Address - Phone:909-461-0040
Mailing Address - Fax:
Practice Address - Street 1:6700 E 129TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80602-4678
Practice Address - Country:US
Practice Address - Phone:909-461-0040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility