| NPI | 1922249440 |
|---|---|
| Other Name | VICTORY CLINIC IV |
| Entity Type | Organization |
| Authorized Contact | DAVID BLANKENSHIP Program Director 989-754-7867 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic (Licence: MI 730208) |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: MI 730208) |
| Enumeration Date | 2009-03-12 |
| Last Update Date | 2009-03-12 |