Victory Clinical Services II LLC
NPI #1497798284 in South Bend, Indiana
Provider Information
- NPI Number
- 1497798284
- Entity Type
- Organization
- Organization Name
- Victory Clinical Services II LLC
- Primary Specialty
- Family Medicine - Addiction Medicine
- Enumeration Date
- Jun 13, 2006
- Last Updated
- Mar 22, 2012
Practice Location
- Address
- 4218 W WESTERN AVE
- City
- South Bend
- State
- Indiana
- ZIP Code
- 46619-2622
- Phone
- (574) 233-1524
Authorized Official
- Name
- MR. DAVID BLANKENSHIP
- Title
- ADMINISTRATIVE DIRECTOR
- Phone
- (574) 233-1524
Specialties & Taxonomy Codes
| Specialty |
|---|
| Psychologist - Health Service — Health Service |
| Nurse Practitioner |
| Family Medicine - Addiction Medicine — Addiction Medicine |
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