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NPI Code Detail

MEDICARE: VICTORY CLINICAL SERVICES BATTLE CREEK LLC

MEDICARE: VICTORY CLINICAL SERVICES BATTLE CREEK LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM2800XMethadone Clinic
2261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center
3261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1801368550
Entity Type Code : Organization
Provider Name (Legal Business Name) : VICTORY CLINICAL SERVICES BATTLE CREEK LLC
Provider Business Mailing Address
First Line : 401 HOWARD ST
Second Line :
City : KALAMAZOO
State : MI
Zip : 49001-2748
Country : US
Telephone Number : 269-344-4458
Fax Number : 269-344-4459
Provider Business Practice Location Address
First Line : 842 COLUMBIA AVE E
Second Line :
City : BATTLE CREEK
State : MI
Zip : 49014-5449
Country : US
Telephone Number : 269-753-1710
Fax Number : 269-753-1717
Authorized Official
Title or Position : FINANCIAL DIRECTOR
Name : RUTH BLANKENSHIP
Credential :
Telephone Number : 269-344-4458
Provider Enumeration Date : 12/19/2018
Last Update Date : 12/19/2018

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Directions to “VICTORY CLINICAL SERVICES BATTLE CREEK LLC ” Practice Location

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