NPI 1306172747

Victory Health Care Agency LLC

Organisation Physical Disabilities Residential Treatment Facility Detroit, MI

Practice location

Address: 5555 Conner Ave Suite 3247, Detroit, MI 48213
Phone: (313) 882-3303
Fax: (313) 571-3304

Authorised official

Name: Joan Dacosta
Title: Manger
Phone: (313) 882-3303

Registered specialties (3)

Physical Disabilities Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320700000X Licence 35304 (MI)

Other Residential Treatment Facility, Physical Disabilities providers in Michigan →

Mental Illness Community Based Residential Treatment Facility

Residential Treatment Facilities Taxonomy 320800000X Licence 35304 (MI)

Other Community Based Residential Treatment Facility, Mental Illness providers in Michigan →

Private Vehicle

Transportation Services Taxonomy 347C00000X Licence 35304 (MI)

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Registry record

NPI: 1306172747
Entity type: Organization
NPI issued: 20 Oct 2009
Record last updated: 23 Nov 2010

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.