Organization
VICTORY BAY RESIDENTIAL SERVICES I, LLC
Active
Organization
VICTORY BAY RESIDENTIAL SERVICES I, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER MELLON (DIRECTOR REGULATORY COMPLIANCE)
(856) 282-5590
Entity
Organization
Contact information
Practice address
19667 TRULL BROOK DR, TARZANA, CA 91356-5630
(856) 282-2028
Mailing address
2940 SUMMIT ST STE 2D, OAKLAND, CA 94609-3416
(856) 282-2028
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
02/13/2024
Last updated
09/17/2024
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