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General NPI Number Information
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NPI Number | 1962392704
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Entity Type | Organization
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Legal Business Name | VICTOR COMMUNITY SUPPORT SERVICES, INC.
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Dates
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Enumeration Date | 07/03/2025
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 97 E BROKAW RD STE 150
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City | SAN JOSE
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State | CA
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Zip | 95112-4221
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Country | US
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Telephone | 408-726-1849
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Fax | 530-230-1264
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Provider Business Mailing Address
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Address Line | 1360 E LASSEN AVE
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City | CHICO
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State | CA
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Zip | 95973-7823
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Country | US
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Telephone | 530-893-0758
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Fax | 530-893-0502
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Authorized Official
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Title or Position | DIRECTOR OF FINANCIAL ANALYSIS
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Name | ANGIE R WIECHERT
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Credential |
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Telephone | 530-230-1210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children 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 | 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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