Provider Demographics
NPI:1831369099
Name:VICTOR COMMUNITY SUPPORT SERVICES, INC.
Entity type:Organization
Organization Name:VICTOR COMMUNITY SUPPORT SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCIAL ANALYSIS
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:WIECHERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-230-1210
Mailing Address - Street 1:1360 E LASSEN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-7823
Mailing Address - Country:US
Mailing Address - Phone:530-893-0758
Mailing Address - Fax:530-893-0502
Practice Address - Street 1:12421 HESPERIA RD
Practice Address - Street 2:STE 1,2&3
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7703
Practice Address - Country:US
Practice Address - Phone:760-245-4695
Practice Address - Fax:760-780-4591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0855X
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01042OtherLEGAL ENTITY #