Victory Health Care Agency LLC

Primary specialty

Physical Disabilities Residential Treatment FacilityTaxonomy code 320700000X

License

35304 Issued in MI

Legal business name

VICTORY HEALTH CARE AGENCY LLC

Practice address

5555 Conner Ave
Suite 3247
Detroit, MI 48213

Phone

(313) 882-3303

Fax

(313) 571-3304

NPI assigned

Oct 20, 2009

Organization subpart

No

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

Authorized official

Name

Joan Dacosta, CNA

Title

Manger

Phone

(313) 882-3303

Specialties & licenses 3

Addresses

Locations

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

{
    "created_epoch": "1255996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1290470400000",
    "number": "1306172747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5555 CONNER AVE",
            "address_2": "SUITE 3247",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "48213",
            "telephone_number": "313-882-3303",
            "fax_number": "313-571-3304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5555 CONNER AVE",
            "address_2": "SUITE 3247",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "48213",
            "telephone_number": "313-882-3303",
            "fax_number": "313-571-3304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY HEALTH CARE AGENCY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-20",
        "last_updated": "2010-11-23",
        "status": "A",
        "authorized_official_last_name": "DACOSTA",
        "authorized_official_first_name": "JOAN",
        "authorized_official_title_or_position": "MANGER",
        "authorized_official_telephone_number": "313-882-3303",
        "authorized_official_credential": "CNA"
    },
    "taxonomies": [
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "MI",
            "license": "35304",
            "primary": true
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "MI",
            "license": "35304",
            "primary": false
        },
        {
            "code": "347C00000X",
            "taxonomy_group": "",
            "desc": "Private Vehicle",
            "state": "MI",
            "license": "35304",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 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.