Healthcare Provider Details

I. General information

NPI: 1962392704
Provider Name (Legal Business Name): VICTOR COMMUNITY SUPPORT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 E BROKAW RD STE 150
SAN JOSE CA
95112-4221
US

IV. Provider business mailing address

1360 E LASSEN AVE
CHICO CA
95973-7823
US

V. Phone/Fax

Practice location:
  • Phone: 408-726-1849
  • Fax: 530-230-1264
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