| Victory Residential Corporation | |
|
1566 E Jeanne Ln San Tan Valley AZ 85140-4046 | |
| (612) 636-3194 | |
| Not Available |
| Full Name | Victory Residential Corporation |
|---|---|
| Speciality | Substance Abuse Rehabilitation Facility |
| Location | 1566 E Jeanne Ln, San Tan Valley, Arizona |
| Authorized Official Name and Position | Xavier Alexander Davis (OWNER / CEO) |
| Authorized Official Contact | 6126363194 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Victory Residential Corporation 1566 E Jeanne Ln San Tan Valley AZ 85140-4046 Ph: (612) 636-3194 | Victory Residential Corporation 1566 E Jeanne Ln San Tan Valley AZ 85140-4046 Ph: (612) 636-3194 |
| NPI Number | 1396420469 |
|---|---|
| Provider Enumeration Date | 06/16/2023 |
| Last Update Date | 06/19/2023 |
| Certification Date | 06/19/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396420469 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 324500000X | Substance Abuse Rehabilitation Facility | (* (Not Available)) | Primary |
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