Healthcare Provider Details

I. General information

NPI: 1558902304
Provider Name (Legal Business Name): VICTORY RECOVERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2019
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7618 MARGATE BLVD
MARGATE FL
33063-3352
US

IV. Provider business mailing address

7618 MARGATE BLVD
MARGATE FL
33063-3352
US

V. Phone/Fax

Practice location:
  • Phone: 561-856-7145
  • Fax:
Mailing address:
  • Phone: 561-856-7145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. SHERITA N CHANG
Title or Position: CRO
Credential:
Phone: 954-993-2040