Healthcare Provider Details

I. General information

NPI: 1033949052
Provider Name (Legal Business Name): VICTORY PROGRAMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 MASSACHUSETTS AVE
BOSTON MA
02118-2613
US

IV. Provider business mailing address

404 S HUNTINGTON AVE
JAMAICA PLAIN MA
02130-4835
US

V. Phone/Fax

Practice location:
  • Phone: 617-541-0222
  • Fax:
Mailing address:
  • Phone: 617-541-0222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. SARAH PORTER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 617-541-0222