VICTORY CLINICAL SERVICES II LLC


Address: 4218 W Western Ave, South Bend, IN 46619-2622
Phone: 5742331524

VICTORY CLINICAL SERVICES II LLC (NPI# 1497798284) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1497798284
Entity Type Organization
Organization Name VICTORY CLINICAL SERVICES II LLC
Practice Address 4218 W Western Ave
South Bend
IN 46619-2622
Practice Telephone 5742331524
Practice Fax Number 5742331612
Mailing Telephone 5742331524
Mailing Fax Number 5742331612
Enumeration Date 2006-06-13
Last Update Date 2012-03-22
Authorized Official Name MR. DAVID BLANKENSHIP (ADMINISTRATIVE DIRECTOR)
Authorized Official Telephone 5742331524
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 103TH0100X Psychologist
Specialization: Health Service
20010221A IN Behavioral Health & Social Service Providers
N 363L00000X Nurse Practitioner 71001833A IN Physician Assistants & Advanced Practice Nursing Providers
Y 207QA0401X Family Medicine
Specialization: Addiction Medicine
02001493A IN Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
IN WOODWARD NPC - NPI 1255432233 01
IN WANG - NPI 1982647434 01
IN 100220790 05
IN 168750 05
IN 200495610 05
IN SHEEHAN HSPP - NPI 1518055565 01

Office Location

Street Address 4218 W WESTERN AVE
City SOUTH BEND
State IN
Zip Code 46619-2622

Providers in the same location

NPI Name Taxonomy Address Enumeration
1578190815 Jeremy Sean Molica Counselor 4218 W Western Ave, South Bend, IN 46619-2622 2020-03-26
1306472659 Kelly Franklin Counselor 4218 W Western Ave, South Bend, IN 46619-2622 2020-03-19
1730689027 Melissa Lewis Counselor 4218 W Western Ave, South Bend, IN 46619-2622 2018-02-14
1912381575 Imani Ingram Counselor 4218 W Western Ave, South Bend, IN 46619-2622 2015-07-14
1811388424 John Anthony Krecek Counselor 4218 W Western Ave, South Bend, IN 46619-2622 2015-02-18
1679988893 Joie Wroblewski Counselor 4218 W Western Ave, South Bend, IN 46619-2622 2014-06-26
1467667733 Andrew R. Guljas Psychologist 4218 W Western Ave, South Bend, IN 46619-2617 2007-05-11
1386858629 Erin T. Lacourt Counselor 4218 W Western Ave, South Bend, IN 46619-2617 2007-05-09

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1578015103 Martin's Super Markets, Inc. Pharmacy 525 S. Mayflower Rd, South Bend, IN 46619 2016-10-31
1124449053 Sandra J Jackson Counselor 4218 Western Ave., South Bend, IN 46619 2013-12-19
1902227911 Patricia Ann Miller Counselor 4218 Western Ave, South Bend, IN 46619 2013-12-17
1740611953 Cynthia G. Finney Counselor 4218 Western Avenue, So Bend, IN 46619 2013-12-13
1437433406 Angela Nicole Zolvinski Pharmacist 4444 W. Western Ave, South Bend, IN 46619 2011-10-07
1871674556 The Health and Hospital Corporation of Marion County Skilled Nursing Facility 4600 W Washington St, South Bend, IN 46619 2006-10-18
1942302203 April Holtgren Family Medicine 1901 #b Western Ave, South Bend, IN 46619 2006-09-05
1447737002 Graciela Jimenez-martinez Registered Nurse 1901 #b Western Avenue, South Bend, IN 46619 2018-07-25
1821397878 Wright Dream In Home Supportive Care 706 S Sheridan St, South Bend, IN 46619 2011-03-16
1740439223 Scott J. Vanslambrouck Dentist 1901 #b Western Avenue, Ihc South Bend, South Bend, IN 46619 2008-09-09
Find all providers in zip 46619

Taxonomy Information

Taxonomy Code 207QA0401X
Grouping Allopathic & Osteopathic Physicians
Classification Family Medicine
Specialization Addiction Medicine

Taxonomy Definition

A family medicine physician who specializes in the diagnosis and treatment of addictions.
Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) was, but is no longer issued by the American Osteopathic Board of Family Physicians.

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1659841880 Dependency Medical Holdings Corporation Family Medicine 5600 W Bradbury Ave, Indianapolis, IN 46241 2018-11-30
1467824698 Acorn Addiction Centers, LLC Family Medicine 1201 N Post Rd Ste 4, Indianapolis, IN 46219-4225 2015-10-27
1134306947 Gerald Paul Myers Family Medicine 3 Park Row, Michigan City, IN 46360 2008-01-23
1043383680 The Kolbe Center Family Medicine 1803 Broad Ripple Ave, Indianapolis, IN 46220-2339 2006-11-15
1336211481 Midwest Integrated Health Systems, P.C. Family Medicine 3300 W 15th Ave, Gary, IN 46404-1963 2006-11-14
1235209156 Elmo Allen Griggs Family Medicine 2811 Washington Ave, Bedford, IN 47421-5310 2006-11-08
1194719757 Lawrence Hastings Schoch Family Medicine 2580 Michigan Rd, Suite 2, Madison, IN 47250-2491 2005-09-09
1609340983 Nwi Behavioral & Addiction Medicine LLC Family Medicine 7805 Taft St, Merrillville, IN 46410-5233 2019-01-19
1134690258 Serenity Primary Care & Recovery LLC Family Medicine 2708 Paoli Pike Ste I, New Albany, IN 47150-5100 2018-12-16
1215411020 Stellhorn Wellness, LLC Family Medicine 3464 Stellhorn Rd, Fort Wayne, IN 46815-4630 2018-09-18
Find all providers with the same taxonomy

Competitor

Search similar providers

City SOUTH BEND
Zip Code 46619

Improve Information

Please comment or provide details below to improve the information on VICTORY CLINICAL SERVICES II LLC.

Dataset Information

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.

Trending Searches