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General NPI Number Information
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NPI Number | 1063100949
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Entity Type | Organization
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Legal Business Name | VICTORIAN HOMES ADULT CARE LLC.
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Dates
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Enumeration Date | 04/27/2023
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 3110 S RURAL RD STE 104
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City | TEMPE
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State | AZ
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Zip | 85282-3869
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Country | US
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Telephone | 480-590-5644
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Fax |
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Provider Business Mailing Address
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Address Line | 1204 E BASELINE RD STE 205
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City | TEMPE
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State | AZ
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Zip | 85283-1453
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Country | US
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Telephone | 602-892-0633
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CONSTANCE VICTORIA BOLTON
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Credential |
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Telephone | 602-892-0633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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