MEDICARE: VICAD HUMAN SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1164417804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICAD HUMAN SERVICES

Provider Business Mailing Address
First Line	:	1710 MISTY FAWN LN
Second Line	:
City	:	FRESNO
State	:	TX
Zip	:	77545-9503
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1710 MISTY FAWN LN
Second Line	:
City	:	FRESNO
State	:	TX
Zip	:	77545-9503
Country	:	US
Telephone Number	:	281-431-5576
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MR. VICTOR UZO ONWUMERE
Credential	:
Telephone Number	:	713-208-0251

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	08/22/2020

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