Organization
VICTORY HEALTH CARE AGENCY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOAN DACOSTA CNA (MANGER)
(313) 882-3303
Entity
Organization
Contact information
Practice address
5555 CONNER AVE, SUITE 3247, DETROIT, MI 48213
(313) 882-3303
(313) 571-3304
Mailing address
5555 CONNER AVE, SUITE 3247, DETROIT, MI 48213
(313) 882-3303
(313) 571-3304
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
Primary
35304
MI
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
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