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General NPI Number Information
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NPI Number | 1831053008
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Entity Type | Organization
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Legal Business Name | VICTORY HOUSE, LLC
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Dates
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Enumeration Date | 12/12/2025
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 481 S CONCORD AVE
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City | WATERTOWN
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State | WI
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Zip | 53094-7307
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Country | US
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Telephone | 414-841-2972
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Fax |
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Provider Business Mailing Address
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Address Line | 217 WISCONSIN AVE STE 201
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City | WAUKESHA
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State | WI
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Zip | 53186-4946
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Country | US
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Telephone | 414-841-2972
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Fax | 414-375-6099
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Authorized Official
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Title or Position | PROGRAM & OPERATIONS ANALYST
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Name | TIFFANY SANCHEZ
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Credential |
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Telephone | 414-858-4141
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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