Organization
VICTA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALEXANDER DONOYAN MBA, LCDP (CEO)
(401) 300-5757
Entity
Organization
Contact information
Practice address
110 ELMWOOD AVE, PROVIDENCE, RI 02907-2423
(401) 300-5757
(401) 300-5656
Mailing address
110 ELMWOOD AVE, PROVIDENCE, RI 02907-2423
(401) 300-5757
(401) 300-5656
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104317007
—
RI
Enumeration date
12/16/2018
Last updated
02/21/2019
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