Organization
VICTORY CLINICAL SERVICES IV, LLC
Active
Other names
Victory Clinic IV
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID BLANKENSHIP (PROGRAM DIRECTOR)
(989) 754-7867
Entity
Organization
Contact information
Practice address
508 SHATTUCK RD, SAGINAW, MI 48604-2329
(989) 754-7867
Mailing address
508 SHATTUCK RD, SAGINAW, MI 48604-2329
(989) 754-7867
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
730208
MI
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
730208
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MI10200M
OTP-SAMHSA ID
MI
Enumeration date
03/12/2009
Last updated
03/12/2009
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