Provider Demographics
NPI:1841021573
Name:VICTORY HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:VICTORY HEALTHCARE SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BODE
Authorized Official - Middle Name:
Authorized Official - Last Name:AKADRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-529-9099
Mailing Address - Street 1:1900 E .NORTHERN PARK WAY SUITE205-207
Mailing Address - Street 2:207
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-3777
Mailing Address - Country:US
Mailing Address - Phone:443-529-9099
Mailing Address - Fax:
Practice Address - Street 1:1900 E .NORTHERN PARK WAY SUITE205-207
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-3777
Practice Address - Country:US
Practice Address - Phone:443-529-9099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty