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General NPI Number Information
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NPI Number | 1700517265
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Entity Type | Organization
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Legal Business Name | VICTORY RECOVERY LLC
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Dates
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Enumeration Date | 06/23/2022
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Last Update Date | 06/23/2022
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Provider Practice Location Address
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Address Line | 1045 E UNIVERSITY DR STE B
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City | MESA
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State | AZ
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Zip | 85203-8000
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Country | US
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Telephone | 480-416-4813
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Fax |
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Provider Business Mailing Address
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Address Line | 1045 E UNIVERSITY DR STE B
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City | MESA
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State | AZ
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Zip | 85203-8000
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | MAX HALL
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Credential |
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Telephone | 480-416-4813
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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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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