VICTORY HEALTH CARE AGENCY LLC (NPI# 1306172747) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306172747 |
| Entity Type | Organization |
| Organization Name | VICTORY HEALTH CARE AGENCY LLC |
| Practice Address |
5555 Conner Ave Suite 3247 Detroit MI 48213 |
| Practice Telephone | 3138823303 |
| Practice Fax Number | 3135713304 |
| Mailing Telephone | 3138823303 |
| Mailing Fax Number | 3135713304 |
| Enumeration Date | 2009-10-20 |
| Last Update Date | 2010-11-23 |
| Authorized Official Name | JOAN DACOSTA (MANGER) |
| Authorized Official Telephone | 3138823303 |
| Authorized Official Credential | CNA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 320800000X | Community Based Residential Treatment Facility, Mental Illness | 35304 | MI | Residential Treatment Facilities |
| N | 347C00000X | Private Vehicle | 35304 | MI | Transportation Services |
| Y | 320700000X | Residential Treatment Facility, Physical Disabilities | 35304 | MI | Residential Treatment Facilities |
| Street Address |
5555 CONNER AVE SUITE 3247 |
| City | DETROIT |
| State | MI |
| Zip Code | 48213 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215540430 | Sheronda Lanetta Blackmon | Licensed Practical Nurse | 13929 Harper Ave., Detroit, MI 48213 | 2020-08-27 |
| 1073049144 | Cheryl Williams | Community Health Worker | 13929 Chalmers Ave., Detroit, MI 48213 | 2017-05-10 |
| 1164963401 | Smile Fresh Detroit PC | Dentist | 7230 Gratiot Avenue, Detroit, MI 48213 | 2017-03-20 |
| 1255887899 | Jay Washington | Behavioral Analyst | 9146 Haper, Detroit, MI 48213 | 2016-09-01 |
| 1396129532 | Sarietha King | Home Health | 14639 Manistique, Detroit, MI 48213 | 2015-07-17 |
| 1366823197 | Royal Treatment Mental Health Systems, LLC | Counselor | 5555 Corner Avenue, Detroit, MI 48213 | 2015-06-17 |
| 1477956779 | Monique Powell | Student in an Organized Health Care Education/Training Program | 5801 Lakeview S.t, Detroit, MI 48213 | 2014-09-30 |
| 1629339163 | Samuel Joseph Farmer | Counselor | 10100 Harper Ave., Detroit, MI 48213 | 2012-05-31 |
| 1609164755 | Vernon Keith Johnson | Social Worker | 20203 Kelly Road, Detroit, MI 48213 | 2011-07-11 |
| 1023312790 | Davenport Quality Home Care LLC | Home Health | 5027 Maxwell, Detroit, MI 48213 | 2011-01-10 |
| Find all providers in zip 48213 | ||||
| Taxonomy Code | 320700000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Physical Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104352285 | Tukeisha Snedecar | Residential Treatment Facility, Physical Disabilities | 19210 Conley St, Detroit, MI 48234-2276 | 2017-05-10 |
| 1760925556 | Connect Care Network Inc. | Residential Treatment Facility, Physical Disabilities | 19761 Annott St, Detroit, MI 48205-1603 | 2016-11-28 |
| 1306390737 | Nikeyla Blakeney | Residential Treatment Facility, Physical Disabilities | 15384 Freeland St, Detroit, MI 48227-2911 | 2016-08-15 |
| 1801249222 | Cm Org | Residential Treatment Facility, Physical Disabilities | 7621 Parkland, Detroit, MI 48239-1031 | 2016-07-20 |
| 1831568500 | Expert Enterprises | Residential Treatment Facility, Physical Disabilities | 18453 Woodingham Dr Uppr, Detroit, MI 48221-2155 | 2015-09-23 |
| 1609209634 | Detroit Family Home | Residential Treatment Facility, Physical Disabilities | 17180 Indiana St, Detroit, MI 48221-2445 | 2013-08-13 |
| 1336332972 | Urban Enterprise | Residential Treatment Facility, Physical Disabilities | 17558 Monica St, Detroit, MI 48221-2635 | 2007-08-27 |
| 1457356453 | Prime Rehab and Physical Therapy Inc | Residential Treatment Facility, Physical Disabilities | 2900 S Fort St, Ste 3, Detroit, MI 48217-1061 | 2005-06-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083173017 | Newport Care Center | Residential Treatment Facility, Physical Disabilities | 22977 Newport St, Southfield, MI 48075-5850 | 2019-03-19 |
| 1750832564 | First Door, LLC | Residential Treatment Facility, Physical Disabilities | 25584 W 10 Mile Rd, Southfield, MI 48033-4826 | 2016-10-17 |
| 1558815068 | Charlie Hudson | Residential Treatment Facility, Physical Disabilities | 15831 Woodworth, Redford, MI 48239-3970 | 2016-08-12 |
| 1548635618 | Milad Jabow | Residential Treatment Facility, Physical Disabilities | 5126 Allison Dr, Troy, MI 48085-3468 | 2015-12-01 |
| 1396113767 | Ltss Inc | Residential Treatment Facility, Physical Disabilities | 3801 S 39 Rd, Cadillac, MI 49601-9126 | 2015-09-02 |
| 1962879759 | Zina Alsalik | Residential Treatment Facility, Physical Disabilities | 19230 Ford Rd, Apt 710, Dearborn, MI 48128-2000 | 2015-08-27 |
| 1851786263 | Cbi Rehabilitation Services, Inc. | Residential Treatment Facility, Physical Disabilities | 3446 E Lake Lansing Rd, East Lansing, MI 48823-1511 | 2015-04-02 |
| 1154719466 | Recovery In Christ Healing Family Program Inc. | Residential Treatment Facility, Physical Disabilities | 7808 Chloe Ct, Belleville, MI 48111-7421 | 2015-01-08 |
| 1396141511 | Apex Real Estate Holdings LLC | Residential Treatment Facility, Physical Disabilities | 4074 Rouge Circle Dr, Troy, MI 48098-4217 | 2014-11-16 |
| 1689087504 | My Home Away From Home Residential & Physical Therapy | Residential Treatment Facility, Physical Disabilities | 1155 W Mcnichols Rd Apt 106, Highland Park, MI 48203-2514 | 2014-06-09 |
| 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.