Vic Medical Services Inc

Primary specialty

Children's Substance Abuse Rehabilitation FacilityTaxonomy code 3245S0500X

Legal business name

VIC MEDICAL SERVICES INC

Practice address

13658 Hawthorne Blvd
Suite 201
Hawthorne, CA 90250-5824

Phone

(310) 219-0212

NPI assigned

Feb 4, 2009

Organization subpart

No

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

Authorized official

Name

Mr. Ike F Udengwu Sr., PA

Title

Secretary

Phone

(310) 493-9393

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1233705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233705600000",
    "number": "1558500181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13658 HAWTHORNE BLVD",
            "address_2": "SUITE 201",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902505824",
            "telephone_number": "310-219-0212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13658 HAWTHORNE BLVD",
            "address_2": "SUITE 201",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902505824",
            "telephone_number": "310-219-0212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIC MEDICAL SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-04",
        "last_updated": "2009-02-04",
        "status": "A",
        "authorized_official_last_name": "UDENGWU",
        "authorized_official_first_name": "IKE",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "310-493-9393",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Andrea Alexandra Villa, PPS
• Chris Socorro Villalobos, CADC II

• Children's Substance Abuse Rehabilitation Facility in Hawthorne, CA
• Providers in Hawthorne, CA by specialty
• Children's Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2009; 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.