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General NPI Number Information
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NPI Number | 1437293842
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Entity Type | Organization
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Legal Business Name | VICTORY FOR LIFE
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Dates
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Enumeration Date | 02/18/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 225 E PRONG RD
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City | RICHMOND
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State | KY
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Zip | 40475-8917
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Country | US
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Telephone | 859-527-7671
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2047
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City | RICHMOND
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State | KY
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Zip | 40476-2047
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Country | US
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Telephone | 859-527-7671
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARY SMYTH
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Credential | LSW
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Telephone | 859-527-7671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | KY
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