VICTA LLC NPI 1457822413

NPI Information

NPI: 1457822413
Provider Name: VICTA LLC
Classification: Clinic/Center - 261QM2800X
Entity Type: Organization

Specialization: Methadone

Address:
110 ELMWOOD AVE
PROVIDENCE, RI
ZIP 02907
Phone: (401) 300-5757
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VICTA LLC is a methadone clinic center in Providence, RI. The provider is an entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction. VICTA LLC NPI is 1457822413. The provider is registered as an organization entity type.

The provider's business location address is:

110 ELMWOOD AVE
PROVIDENCE, RI
ZIP 02907-423
Phone: (401) 300-5757
Fax: (401) 300-5656

The provider's authorized official is Alexander Donoyan .
The authorized official title is Ceo and has the following contact phone number (401) 300-5757.

The enumeration date for this NPI number is 12/16/2018 and was last updated on 2/21/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM2800X	Clinic/Center	Methadone			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1104317007	MEDICAID	RHODE ISLAND

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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