Victory Group Home LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

VICTORY GROUP HOME LLC

Practice address

9127 W Minnezona Ave
Phoenix, AZ 85037-2446

Phone

(469) 648-8397

NPI assigned

Aug 6, 2021

Organization subpart

No

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

Authorized official

Name

Evelyne Dusabe

Title

Administrator

Phone

(469) 648-8397

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Tax ID family

Victory Group Home LLC2 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.

• Victory Group Home LLC#2

  • Mental Illness Community Based Residential Treatment Facility
  • Phoenix, AZ
  • NPI 1962152280
  NPD tax ID

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

{
    "created_epoch": "1628208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628208000000",
    "number": "1639843279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9127 W MINNEZONA AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850372446",
            "telephone_number": "469-648-8397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9127 W MINNEZONA AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850372446",
            "telephone_number": "469-648-8397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY GROUP HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-06",
        "last_updated": "2021-08-06",
        "certification_date": "2021-08-06",
        "status": "A",
        "authorized_official_last_name": "DUSABE",
        "authorized_official_first_name": "EVELYNE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "469-648-8397"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BH LICENSE",
            "identifier": "BH6785",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "INTERNET",
            "affiliation": "N",
            "address_1": "9127 W Minnezona Ave",
            "city": "Phoenix",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "850372446",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sami Victor, M.D.
• Victorious Assited Living Home, LLC
• Victorious Lifestyle LLC
• Victory Behavioral Healthcare PLLC
• Victory Collegiate Academy Corp.
• Victory Group Home LLC#2
• Victory Health Home PLLC
• Victory Sports Therapy, PLLC
• Vidadyne Healthcare LLC
• Edward Vidal, FNP

• Mental Illness Community Based Residential Treatment Facility in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Mental Illness Community Based Residential Treatment Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2021; 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.