Provider Demographics
NPI:1386812436
Name:VICTORIA HOUSE, INC.
Entity type:Organization
Organization Name:VICTORIA HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-584-2314
Mailing Address - Street 1:1752 MORGAN WHIDDON RD
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32347-2145
Mailing Address - Country:US
Mailing Address - Phone:850-584-2314
Mailing Address - Fax:850-223-1244
Practice Address - Street 1:907 W WILCOX ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32347-2422
Practice Address - Country:US
Practice Address - Phone:850-584-7408
Practice Address - Fax:850-223-1244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No347C00000XTransportation ServicesPrivate Vehicle
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child