Healthcare Provider Details

I. General information

NPI: 1801368550
Provider Name (Legal Business Name): VICTORY CLINICAL SERVICES BATTLE CREEK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2018
Last Update Date: 12/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

842 COLUMBIA AVE E
BATTLE CREEK MI
49014-5449
US

IV. Provider business mailing address

401 HOWARD ST
KALAMAZOO MI
49001-2748
US

V. Phone/Fax

Practice location:
  • Phone: 269-753-1710
  • Fax: 269-753-1717
Mailing address:
  • Phone: 269-344-4458
  • Fax: 269-344-4459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RUTH BLANKENSHIP
Title or Position: FINANCIAL DIRECTOR
Credential:
Phone: 269-344-4458