Victory Bay Residential Services I, LLC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

VICTORY BAY RESIDENTIAL SERVICES I, LLC

Practice address

19667 Trull Brook Dr
Tarzana, CA 91356-5630

Phone

(856) 282-2028

NPI assigned

Feb 13, 2024

Organization subpart

No

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

Authorized official

Name

Jennifer Mellon

Title

Director Regulatory Compliance

Phone

(856) 282-5590

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1707782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726531200000",
    "number": "1609630276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2940 SUMMIT ST STE 2D",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093416",
            "telephone_number": "856-282-2028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19667 TRULL BROOK DR",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913565630",
            "telephone_number": "856-282-2028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY BAY RESIDENTIAL SERVICES I, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-13",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A",
        "authorized_official_last_name": "MELLON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "DIRECTOR REGULATORY COMPLIANCE",
        "authorized_official_telephone_number": "856-282-5590"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Health Service Clinic/Center in Tarzana, CA
• Providers in Tarzana, CA by specialty
• Health Service Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.