Victory Life Health Services

Primary specialty

Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X

Legal business name

VICTORY LIFE HEALTH SERVICES

Doing business as

The Bridge into Wellness Center

Practice address

95 E High St Ste 104
Waynesburg, PA 15370-1853

Phone

(716) 456-1225

NPI assigned

Apr 6, 2016

Last updated

Apr 6, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Marisa TerryNPI 1750611661

Title

Owner

Phone

(716) 456-1225

Specialties & licenses 1

Addresses

Other names 1

• The Bridge into Wellness Center Doing business as

Locations

Practitioners 1

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.

• Marisa Terry, LPN

  • Licensed Practical Nurse
  • Cheektowaga, NY
  • NPI 1750611661
  NPD (past) Authorized official

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

{
    "created_epoch": "1459900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459900800000",
    "number": "1366806358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6221 ROUTE 474",
            "city": "ASHVILLE",
            "state": "NY",
            "postal_code": "147109788",
            "telephone_number": "716-782-4158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 E HIGH ST STE 104",
            "city": "WAYNESBURG",
            "state": "PA",
            "postal_code": "153701853",
            "telephone_number": "716-456-1225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY LIFE HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-06",
        "last_updated": "2016-04-06",
        "status": "A",
        "authorized_official_last_name": "TERRY",
        "authorized_official_first_name": "MARISA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "716-456-1225"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Bridge into Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• United Cerebral Palsy SW PA
• Upmc Greene (Washington Health System Greene)
• Upmc Greene (Washington Health System Greene)
• Upmc Greene (Washington Health System Greene)
• Maryann Verbus
• Darren James William Vidal, MA, LPC, NCC
• Erin Virgili, MS, SLP
• Prafullchandra Dolatrai Vora, M.D.
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-5446)
• Jennifer Lynne Walker, MED, LPC

• Addiction Medicine (Family Medicine) Physician in Waynesburg, PA
• Providers in Waynesburg, PA by specialty
• Addiction Medicine (Family Medicine) Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2016; 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.