Organization
VICTORY GROUP HOME LLC#2
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EVELYNE DUSABE (OF)
(623) 248-8548
Entity
Organization
Contact information
Practice address
9162 W SELLS DR, PHOENIX, AZ 85037-0805
(469) 648-8397
Mailing address
9162 W SELLS DR, PHOENIX, AZ 85037-0805
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
BH7450
—
AZ
Enumeration date
03/28/2022
Last updated
03/28/2022
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