Healthcare Provider Details

I. General information

NPI: 1184926495
Provider Name (Legal Business Name): VICTOR COMMUNITY SUPPORT SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2010
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E MAIN ST STE 113-117
BARSTOW CA
92311-2361
US

IV. Provider business mailing address

1360 E LASSEN AVE
CHICO CA
95973-7823
US

V. Phone/Fax

Practice location:
  • Phone: 760-245-4695
  • Fax: 760-513-4696
Mailing address:
  • Phone: 530-893-0758
  • Fax: 530-893-0502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGIE R WIECHERT
Title or Position: DIRECTOR OF FINANCIAL ANALYSIS
Credential:
Phone: 530-230-1210