NPIMap

Organization Active NPI

Victory Palace

  • Adult Care Home Facility
  • Grand Rapids, MI
National Provider Identifier
1104126754
Registry record updated Oct 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Care Home FacilityTaxonomy code 311ZA0620X
License
AF410306794 Issued in MI
Legal business name
VICTORY PALACE
Practice address
908 College Ave NE
Grand Rapids, MI 49503-1751
Phone
(616) 214-8155
Fax
(616) 214-8155
NPI assigned
Oct 29, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Ime Etuk
Title
Managing Director
Phone
(616) 881-3843

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X AF410306794 MI Primary

Addresses

Primary practice location

908 College Ave NE
Grand Rapids, MI 49503-1751

Mailing address

908 College Ave NE
Grand Rapids, MI 49503-1751
Phone (616) 214-8155

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1288310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288310400000",
    "number": "1104126754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "908 COLLEGE AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495031751",
            "telephone_number": "616-214-8155",
            "fax_number": "616-214-8155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "908 COLLEGE AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495031751",
            "telephone_number": "616-214-8155",
            "fax_number": "616-214-8155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY PALACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-29",
        "last_updated": "2010-10-29",
        "status": "A",
        "authorized_official_last_name": "ETUK",
        "authorized_official_first_name": "IME",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "616-881-3843",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "MI",
            "license": "AF410306794",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.