| NPI | 1033579651 |
|---|---|
| Doing Business As | 14TH ST |
| Doing Business As | VICTORIA GROUP HOME |
| Entity Type | Organization |
| Authorized Contact | BRANDI TURNER Licensing Coordinator 682-707-2756 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 315P00000X Intermediate Care Facility, Intellectual Disabilities |
| Enumeration Date | 2016-02-24 |
| Last Update Date | 2025-03-12 |