Provider Demographics
NPI:1366170482
Name:C & R VICTORY HOUSE LLC
Entity type:Organization
Organization Name:C & R VICTORY HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:TERRELL
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-892-0056
Mailing Address - Street 1:2708 BRIERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-2902
Mailing Address - Country:US
Mailing Address - Phone:804-892-0056
Mailing Address - Fax:
Practice Address - Street 1:2708 BRIERWOOD RD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-2902
Practice Address - Country:US
Practice Address - Phone:804-892-0056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services