Provider Demographics
NPI:1831567718
Name:VICTORY CHRISTIAN OUTREACH CENTER
Entity type:Organization
Organization Name:VICTORY CHRISTIAN OUTREACH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:VEAL
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:318-229-9596
Mailing Address - Street 1:P O BOX 4572
Mailing Address - Street 2:3523 RIGOLETTE RD.
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71361
Mailing Address - Country:US
Mailing Address - Phone:318-229-9596
Mailing Address - Fax:318-704-3111
Practice Address - Street 1:3523 RIGOLETTE RD.
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71361-4572
Practice Address - Country:US
Practice Address - Phone:318-229-9596
Practice Address - Fax:318-704-3111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)