Basic Information
| Provider Information | |||||||||
| NPI: | 1801368550 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VICTORY CLINICAL SERVICES BATTLE CREEK LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 HOWARD ST | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490012748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693444458 | ||||||||
| FaxNumber: | 2693444459 | ||||||||
| Practice Location | |||||||||
| Address1: | 842 COLUMBIA AVE E | ||||||||
| Address2: | |||||||||
| City: | BATTLE CREEK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490145449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2697531710 | ||||||||
| FaxNumber: | 2697531717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2018 | ||||||||
| LastUpdateDate: | 12/19/2018 | ||||||||
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| AuthorizedOfficialLastName: | BLANKENSHIP | ||||||||
| AuthorizedOfficialFirstName: | RUTH | ||||||||
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| AuthorizedOfficialTitleorPosition: | FINANCIAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2693444458 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2800X | N | Ambulatory Health Care Facilities | Clinic/Center | Methadone Clinic | 261QR0405X | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.