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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