Victory Group Home LLC#2

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

VICTORY GROUP HOME LLC#2

Practice address

9162 W Sells Dr
Phoenix, AZ 85037-0805

Phone

(469) 648-8397

NPI assigned

Mar 28, 2022

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

Of

Phone

(623) 248-8548

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

  • Mental Illness Community Based Residential Treatment Facility
  • Phoenix, AZ
  • NPI 1639843279
  NPD tax ID

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

{
    "created_epoch": "1648425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648425600000",
    "number": "1962152280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9162 W SELLS DR",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850370805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9162 W SELLS DR",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850370805",
            "telephone_number": "469-648-8397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY GROUP HOME LLC#2",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-28",
        "last_updated": "2022-03-28",
        "certification_date": "2022-03-28",
        "status": "A",
        "authorized_official_last_name": "DUSABE",
        "authorized_official_first_name": "EVELYNE",
        "authorized_official_title_or_position": "OF",
        "authorized_official_telephone_number": "623-248-8548"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "BH7450",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "INTERNET",
            "affiliation": "N",
            "address_1": "9162 W Sells Dr",
            "city": "Phoenix",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "850370805",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Victorious Assited Living Home, LLC
• Victorious Lifestyle LLC
• Victory Behavioral Healthcare PLLC
• Victory Collegiate Academy Corp.
• Victory Group Home LLC
• Victory Health Home PLLC
• Victory Sports Therapy, PLLC
• Vidadyne Healthcare LLC
• Edward Vidal, FNP
• Maria Vidale

• 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 Mar 28, 2022; 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.