# VICTORY HEALTH CARE AGENCY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306172747
- **Authorized official:** JOAN DACOSTA CNA (MANGER)
- **Authorized official phone:** (313) 882-3303

## Contact information

- **Practice address:** 5555 CONNER AVE, SUITE 3247, DETROIT, MI 48213
- **Practice address phone:** (313) 882-3303
- **Practice address fax:** (313) 571-3304
- **Mailing address:** 5555 CONNER AVE, SUITE 3247, DETROIT, MI 48213
- **Mailing address phone:** (313) 882-3303
- **Mailing address fax:** (313) 571-3304

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320700000X | Physical Disabilities Residential Treatment Facility | 35304 | MI | Yes |
| 320800000X | Mental Illness Community Based Residential Treatment Facility | 35304 | MI | — |
| 347C00000X | Private Vehicle | 35304 | MI | — |

## Other

- **Enumeration date:** 10/20/2009
- **Last updated:** 11/23/2010