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General NPI Number Information
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NPI Number | 1053855023
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Entity Type | Organization
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Legal Business Name | VICTORIAS HOUSE, LLC
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Dates
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Enumeration Date | 12/11/2016
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Last Update Date | 12/11/2016
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Provider Practice Location Address
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Address Line | 1813 12TH ST UNIT A
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City | SANTA MONICA
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State | CA
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Zip | 90404-4637
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Country | US
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Telephone | 310-447-1335
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Fax |
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Provider Business Mailing Address
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Address Line | 1813 12TH STREET UNIT A
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City | SANTA MONICA
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State | CA
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Zip | 90404
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Country | US
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Telephone | 310-447-1335
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Fax |
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Authorized Official
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Title or Position | CEO DIRECTOR OF OPERATIONS
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Name | MS. JENEVIEVE MINELIAN
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Credential |
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Telephone | 310-447-1335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 190955AP
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License Number State | CA
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