VICTORY MOUNTAIN, INC. (NPI# 1275850869) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275850869 |
| Entity Type | Organization |
| Organization Name | VICTORY MOUNTAIN, INC. |
| Other Organization Name | VICTORY MOUNTAIN BOYS RANCH |
| Practice Address |
148 Bowling Ln Ironton MO 63650-4148 |
| Practice Telephone | 5735467592 |
| Practice Fax Number | 5735460125 |
| Mailing Telephone | 5735467592 |
| Mailing Fax Number | 5735460125 |
| Enumeration Date | 2010-04-22 |
| Last Update Date | 2010-04-22 |
| Authorized Official Name | MR. CHRISTOPHER SHAWN SKINNER (PRESIDENT) |
| Authorized Official Telephone | 5735467592 |
| Authorized Official Credential | M.A., L.P.C. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | 001770712 | MO | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Victory Mountain Boys Ranch | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295954741 | Victory Mountain, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | Hc 69 Box 1455, Ironton, MO 63650-9606 | 2007-04-24 |
| Street Address |
148 BOWLING LN |
| City | IRONTON |
| State | MO |
| Zip Code | 63650-4148 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972756633 | East Missouri Action Agency, Inc | Clinic/Center | 606 West Russell, Ironton, MO 63650 | 2008-10-28 |
| 1326008533 | Vatana C. Boonyasai | Family Medicine | 200 St.mary's Street, Lower Level, Pilot Knob, MO 63650 | 2006-03-23 |
| 1194074302 | Robert Franklin Dettmer Sr. | General Practice | 3 Longwood Lane, Ironton, MO 63650-0307 | 2012-09-04 |
| 1578542924 | Arcadia Valley Drug Acquisition Co | Durable Medical Equipment & Medical Supplies | 605 N Main St, Ironton, MO 63650-1006 | 2006-01-13 |
| 1053978643 | Michelle Bobbett | Pharmacist | 605 N Main St, Ironton, MO 63650-1006 | 2019-05-20 |
| 1184016578 | Rebecca Barron | Pharmacist | 605 N Main St, Ironton, MO 63650-1006 | 2015-02-23 |
| 1902152929 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 605 N Main St, Ironton, MO 63650-1006 | 2012-07-27 |
| 1831457027 | Frederick G Dietzler | Pharmacist | 605 N Main St, Ironton, MO 63650-1006 | 2012-04-25 |
| 1831417682 | Southeast Missouri Behavioral Health | Clinic/Center | 143 S Main St, Ironton, MO 63650-1305 | 2010-05-04 |
| 1942451083 | Erika Michelle Parks | Pharmacist | 124 W Russell St, Ironton, MO 63650-1313 | 2008-10-07 |
| Find all providers in zip 63650 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295954741 | Victory Mountain, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | Hc 69 Box 1455, Ironton, MO 63650-9606 | 2007-04-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609474204 | Whetstone Boys Ranch | Residential Treatment Facility, Emotionally Disturbed Children | 6850 County Road 2660, Mountain View, MO 65548-8146 | 2020-10-15 |
| 1962995993 | The Bridge Home for Children | Residential Treatment Facility, Emotionally Disturbed Children | 6033 Swope Pkwy, Kansas City, MO 64130-4461 | 2018-06-13 |
| 1437675477 | Kybama, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 12729 Stoney Point Rd, Bonne Terre, MO 63628 | 2017-08-22 |
| 1568914927 | Clear Creek Counseling | Residential Treatment Facility, Emotionally Disturbed Children | 3646 N Farm Road 89, Willard, MO 65781-8330 | 2016-11-01 |
| 1619330578 | Farmer Grove Homesteads Incorporated | Residential Treatment Facility, Emotionally Disturbed Children | 533 E Bedford St, Marshfield, MO 65706-1218 | 2016-03-29 |
| 1720447212 | Corner Stones of Care | Residential Treatment Facility, Emotionally Disturbed Children | 300 E 36th St, Kansas City, MO 64111-1410 | 2016-02-12 |
| 1558729509 | Cayman's House of Hope, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 311 N Poplar St, Fair Play, MO 65649-9299 | 2016-02-05 |
| 1639503691 | Proverb Academy, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 420 Carroll St, Morehouse, MO 63868 | 2013-08-27 |
| 1306147277 | Fair Haven Children's Home | Residential Treatment Facility, Emotionally Disturbed Children | 3132 N Fair Haven Loop, Strafford, MO 65757-8619 | 2010-11-09 |
| 1437470184 | Ozarks Teen Challenge | Residential Treatment Facility, Emotionally Disturbed Children | 512 Purist Lane, Branson West, MO 65737 | 2010-06-17 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.