Victory Lake Operations, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

00308961 Issued in NY

Legal business name

VICTORY LAKE OPERATIONS, LLC

Practice address

958 Church St
Baldwin, NY 11510-4257

Phone

(516) 409-0700

Fax

(516) 809-0161

NPI assigned

Oct 4, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Gerald J Wood, CPA

Title

Member

Phone

(845) 229-9177

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Victory Lake Operations LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Victory Lake Operations, LLC

  • Skilled Nursing Facility
  • Hyde Park, NY
  • NPI 1164419511
  NPD tax ID

Locations

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

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1174510259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "958 CHURCH ST",
            "city": "BALDWIN",
            "state": "NY",
            "postal_code": "115104257",
            "telephone_number": "516-409-0700",
            "fax_number": "516-809-0161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "958 CHURCH ST",
            "city": "BALDWIN",
            "state": "NY",
            "postal_code": "115104257",
            "telephone_number": "516-409-0700",
            "fax_number": "516-809-0161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY LAKE OPERATIONS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WOOD",
        "authorized_official_first_name": "GERALD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "845-229-9177",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NY",
            "license": "00308961",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00308961",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nanda Akke Veenstra, MS CCC SLP
• Maria Cristina Velez
• Sonya Sheron Ventour, MD
• Amberleigh Verhagen
• Marina Harry Victor, LPN
• Tamar Taura Vieux
• Rodrick Anthony Walker, PMHNP
• Carol Wallace
• Tanya B Wallace
• Xiaoya Wang, O.M.D., L.AC

• Skilled Nursing Facility in Baldwin, NY
• Providers in Baldwin, NY by specialty
• Skilled Nursing Facility in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.