Provider Demographics
NPI:1881753663
Name:VICTOR TREATMENT CENTERS, INC.
Entity type:Organization
Organization Name:VICTOR TREATMENT CENTERS, 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:530-230-1280
Practice Address - Street 1:3164 CONDO CT
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2557
Practice Address - Country:US
Practice Address - Phone:707-576-7218
Practice Address - Fax:707-576-7243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
322D00000X
CA320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00118OtherLEGAL ENTITY NUMBER - MH