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General NPI Number Information
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NPI Number | 1770604472
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Entity Type | Organization
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Legal Business Name | VICTORY PROGRAMS, INC.
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 404 S HUNTINGTON AVE
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City | JAMAICA PLAIN
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State | MA
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Zip | 02130-4835
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Country | US
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Telephone | 617-541-0222
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Fax | 617-541-0040
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Provider Business Mailing Address
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Address Line | 404 S HUNTINGTON AVE
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City | JAMAICA PLAIN
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State | MA
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Zip | 02130-4835
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Country | US
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Telephone | 617-541-0222
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Fax | 617-541-0040
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. SARAH PORTER
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Credential |
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Telephone | 617-541-0222
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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 | 324500000X
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License Number State | MA
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