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General NPI Number Information
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NPI Number | 1952280026
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Entity Type | Organization
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Legal Business Name | SACRED VILLAGE CENTER
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Dates
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Enumeration Date | 09/01/2025
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 11727 CHARWOOD RD
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City | VICTORVILLE
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State | CA
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Zip | 92392-0415
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Country | US
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Telephone | 775-316-1971
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Fax |
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Provider Business Mailing Address
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Address Line | 11727 CHARWOOD RD
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City | VICTORVILLE
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State | CA
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Zip | 92392-0415
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Country | US
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Telephone | 775-316-1971
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TRENISHA L KUNZI
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Credential |
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Telephone | 775-316-1971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment 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 | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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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 | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #7
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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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