Healthcare Provider Details

I. General information

NPI: 1972689370
Provider Name (Legal Business Name): VICTOR COMMUNITY SUPPORT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 E LASSEN AVE
CHICO CA
95973-7823
US

IV. Provider business mailing address

1360 E LASSEN AVE
CHICO CA
95973-7823
US

V. Phone/Fax

Practice location:
  • Phone: 530-893-0758
  • Fax: 530-893-0502
Mailing address:
  • Phone: 530-893-0758
  • Fax: 530-893-0502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number261QM0855X
License Number StateCA

VIII. Authorized Official

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