NPIMap

Organization Active NPI

Victory Ridge Academy, Inc.

  • Clinic/Center
  • Lake Wales, FL
National Provider Identifier
1184044612
Registry record updated Nov 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
VICTORY RIDGE ACADEMY, INC.
Practice address
501 Burns Ave
Lake Wales, FL 33853-3335
Phone
(863) 679-3338
Fax
(863) 679-3944
NPI assigned
Apr 23, 2014
Last updated
Nov 8, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2022

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

Authorized official

Name
Steven Whitaker
Title
Executive Director
Phone
(863) 679-3338

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary
Physical Therapist 225100000X NU
Occupational Therapist 225X00000X NU
Speech-Language Pathologist 235Z00000X FL
Behavior Analyst 103K00000X FL

Addresses

Primary practice location

501 Burns Ave
Lake Wales, FL 33853-3335

Mailing address

501 Burns Ave
Lake Wales, FL 33853-3335
Phone (863) 679-3338

Other identifiers 1

IdentifierTypeStateIssuer
010977000MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Our Children's Academy2 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.

Locations

427 Burns Ave
Lake Wales, FL 33853
Phone (863) 679-3338

501 Burns Ave
Lake Wales, FL 33853
Phone (863) 679-3338

Practitioners & affiliated clinicians

Practitioners 46

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 46

NPI Registry JSON

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

{
    "created_epoch": "1398211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667865600000",
    "number": "1184044612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 BURNS AVE",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338533335",
            "telephone_number": "863-679-3338",
            "fax_number": "863-679-3944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 BURNS AVE",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338533335",
            "telephone_number": "863-679-3338",
            "fax_number": "863-679-3944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY RIDGE ACADEMY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-23",
        "last_updated": "2022-11-08",
        "certification_date": "2022-11-08",
        "status": "A",
        "authorized_official_last_name": "WHITAKER",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "863-679-3338"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "FL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010977000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Wales, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2022; 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.