Healthcare Provider Details

I. General information

NPI: 1831053008
Provider Name (Legal Business Name): VICTORY HOUSE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

481 S CONCORD AVE
WATERTOWN WI
53094-7307
US

IV. Provider business mailing address

217 WISCONSIN AVE STE 201
WAUKESHA WI
53186-4946
US

V. Phone/Fax

Practice location:
  • Phone: 414-841-2972
  • Fax:
Mailing address:
  • Phone: 414-841-2972
  • Fax: 414-375-6099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY SANCHEZ
Title or Position: PROGRAM & OPERATIONS ANALYST
Credential:
Phone: 414-858-4141