Healthcare Provider Details

I. General information

NPI: 1588110506
Provider Name (Legal Business Name): VICTORY FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 TRUXTUN AVE STE 202
BAKERSFIELD CA
93309-0523
US

IV. Provider business mailing address

4200 TRUXTUN AVE STE 202
BAKERSFIELD CA
93309-0523
US

V. Phone/Fax

Practice location:
  • Phone: 661-912-0111
  • Fax: 661-742-1606
Mailing address:
  • Phone: 661-912-0111
  • Fax: 661-742-1606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: CHRISTOPHER MICHEAL REILLY
Title or Position: CEO
Credential:
Phone: 661-912-0111