VICTORY CLINICAL SERVICES IV LLC NPI 1922249440

NPI Information

NPI: 1922249440
Provider Name: VICTORY CLINICAL SERVICES IV, LLC

Other Name: VICTORY CLINIC IV

Classification: Clinic/Center - 261QM2800X
Entity Type: Organization

Specialization: Methadone

Address:
508 SHATTUCK RD
SAGINAW, MI
ZIP 48604
Phone: (989) 754-7867
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VICTORY CLINICAL SERVICES IV, LLC is a methadone clinic center in Saginaw, MI. 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. VICTORY CLINICAL SERVICES IV, LLC NPI is 1922249440. The provider is registered as an organization entity type.
The provider Other Name Is Victory Clinic Iv.

The provider's business location address is:

508 SHATTUCK RD
SAGINAW, MI
ZIP 48604-329
Phone: (989) 754-7867

The provider's authorized official is David Blankenship .
The authorized official title is Program Director and has the following contact phone number (989) 754-7867.

The enumeration date for this NPI number is 3/12/2009 and was last updated on 3/12/2009.

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	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder	730208	MICHIGAN	No
2	261QM2800X	Clinic/Center	Methadone	730208	MICHIGAN	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	MI10200M	OTHER	MICHIGAN	OTP-SAMHSA ID

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: 11/14/2023

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