Healthcare Provider Details

I. General information

NPI: 1922306620
Provider Name (Legal Business Name): VICTOR COMMUNITY SUPPORT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2011
Last Update Date: 05/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N PERRIS BLVD
PERRIS CA
92571-2811
US

IV. Provider business mailing address

1360 E LASSEN AVE
CHICO CA
95973-7823
US

V. Phone/Fax

Practice location:
  • Phone: 951-436-5300
  • Fax: 951-436-5350
Mailing address:
  • Phone: 530-893-0758
  • Fax: 530-893-0502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANGIE WIECHERT
Title or Position: MANAGER OF FINANCIAL PLANNING
Credential:
Phone: 503-230-1210