MEDICARE: VICTOR TREATMENT CENTERS, INC.

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	320800000X	Mental Illness Community Based Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00118	OTHER	CA	LEGAL ENTITY NUMBER MH

General Provider Information

NPI Number	:	1972652824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICTOR TREATMENT CENTERS, INC.

Provider Business Mailing Address
First Line	:	1360 E LASSEN AVE
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95973-7823
Country	:	US
Telephone Number	:	530-893-0758
Fax Number	:

Provider Business Practice Location Address
First Line	:	1360 E LASSEN AVE
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95973-7823
Country	:	US
Telephone Number	:	530-893-0758
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MR. LENNY RAY VERSER JR.
Credential	:
Telephone Number	:	530-893-0758

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	02/13/2013

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