Provider Demographics
NPI:1316658479
Name:VICTORY RESIDENTIAL SERVICES LLC
Entity type:Organization
Organization Name:VICTORY RESIDENTIAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:MANZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-531-0642
Mailing Address - Street 1:51 ASTER LN APT 8
Mailing Address - Street 2:
Mailing Address - City:CAPE ELIZABETH
Mailing Address - State:ME
Mailing Address - Zip Code:04107-5139
Mailing Address - Country:US
Mailing Address - Phone:202-321-2707
Mailing Address - Fax:
Practice Address - Street 1:51 ASTER LN APT 8
Practice Address - Street 2:
Practice Address - City:CAPE ELIZABETH
Practice Address - State:ME
Practice Address - Zip Code:04107-5139
Practice Address - Country:US
Practice Address - Phone:202-321-2707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care