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General NPI Number Information
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NPI Number | 1922822071
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Entity Type | Organization
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Legal Business Name | VICTORIA MEADOWS LLC
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 140908 ELK HAVEN WAY
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City | CRESCENT LAKE
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State | OR
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Zip | 97733-7069
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Country | US
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Telephone | 541-433-2435
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Fax |
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Provider Business Mailing Address
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Address Line | 2660 NE HIGHWAY 20 STE 610-365
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City | BEND
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State | OR
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Zip | 97701-6402
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Country | US
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Telephone | 541-433-2435
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | JOSEPH COLE MCGOWAN
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Credential |
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Telephone | 415-590-0440
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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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