Organization
ILLUMINATING VICTORY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TERRI CARTER-GRAVES (CHIEF EXECUTIVE OFFICER)
(614) 984-3838
Entity
Organization
Contact information
Practice address
976 N NELSON RD, COLUMBUS, OH 43219-2608
(614) 984-3838
Mailing address
PO BOX 11701, COLUMBUS, OH 43211-0701
(614) 984-3838
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QR0800X
Recovery Care Clinic/Center
—
—
305S00000X
Point of Service
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
10/30/2023
Last updated
10/30/2023
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