VICTORY CLINICAL SERVICES II LLC (NPI# 1497798284) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497798284 |
| Entity Type | Organization |
| Organization Name | VICTORY CLINICAL SERVICES II LLC |
| Practice Address |
4218 W Western Ave South Bend IN 46619-2622 |
| Practice Telephone | 5742331524 |
| Practice Fax Number | 5742331612 |
| Mailing Telephone | 5742331524 |
| Mailing Fax Number | 5742331612 |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2012-03-22 |
| Authorized Official Name | MR. DAVID BLANKENSHIP (ADMINISTRATIVE DIRECTOR) |
| Authorized Official Telephone | 5742331524 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TH0100X |
Psychologist Specialization: Health Service |
20010221A | IN | Behavioral Health & Social Service Providers |
| N | 363L00000X | Nurse Practitioner | 71001833A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 207QA0401X |
Family Medicine Specialization: Addiction Medicine |
02001493A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | WOODWARD NPC - NPI | 1255432233 | 01 |
| IN | WANG - NPI | 1982647434 | 01 |
| IN | 100220790 | 05 | |
| IN | 168750 | 05 | |
| IN | 200495610 | 05 | |
| IN | SHEEHAN HSPP - NPI | 1518055565 | 01 |
| Street Address |
4218 W WESTERN AVE |
| City | SOUTH BEND |
| State | IN |
| Zip Code | 46619-2622 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578190815 | Jeremy Sean Molica | Counselor | 4218 W Western Ave, South Bend, IN 46619-2622 | 2020-03-26 |
| 1306472659 | Kelly Franklin | Counselor | 4218 W Western Ave, South Bend, IN 46619-2622 | 2020-03-19 |
| 1730689027 | Melissa Lewis | Counselor | 4218 W Western Ave, South Bend, IN 46619-2622 | 2018-02-14 |
| 1912381575 | Imani Ingram | Counselor | 4218 W Western Ave, South Bend, IN 46619-2622 | 2015-07-14 |
| 1811388424 | John Anthony Krecek | Counselor | 4218 W Western Ave, South Bend, IN 46619-2622 | 2015-02-18 |
| 1679988893 | Joie Wroblewski | Counselor | 4218 W Western Ave, South Bend, IN 46619-2622 | 2014-06-26 |
| 1467667733 | Andrew R. Guljas | Psychologist | 4218 W Western Ave, South Bend, IN 46619-2617 | 2007-05-11 |
| 1386858629 | Erin T. Lacourt | Counselor | 4218 W Western Ave, South Bend, IN 46619-2617 | 2007-05-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578015103 | Martin's Super Markets, Inc. | Pharmacy | 525 S. Mayflower Rd, South Bend, IN 46619 | 2016-10-31 |
| 1124449053 | Sandra J Jackson | Counselor | 4218 Western Ave., South Bend, IN 46619 | 2013-12-19 |
| 1902227911 | Patricia Ann Miller | Counselor | 4218 Western Ave, South Bend, IN 46619 | 2013-12-17 |
| 1740611953 | Cynthia G. Finney | Counselor | 4218 Western Avenue, So Bend, IN 46619 | 2013-12-13 |
| 1437433406 | Angela Nicole Zolvinski | Pharmacist | 4444 W. Western Ave, South Bend, IN 46619 | 2011-10-07 |
| 1871674556 | The Health and Hospital Corporation of Marion County | Skilled Nursing Facility | 4600 W Washington St, South Bend, IN 46619 | 2006-10-18 |
| 1942302203 | April Holtgren | Family Medicine | 1901 #b Western Ave, South Bend, IN 46619 | 2006-09-05 |
| 1447737002 | Graciela Jimenez-martinez | Registered Nurse | 1901 #b Western Avenue, South Bend, IN 46619 | 2018-07-25 |
| 1821397878 | Wright Dream | In Home Supportive Care | 706 S Sheridan St, South Bend, IN 46619 | 2011-03-16 |
| 1740439223 | Scott J. Vanslambrouck | Dentist | 1901 #b Western Avenue, Ihc South Bend, South Bend, IN 46619 | 2008-09-09 |
| Find all providers in zip 46619 | ||||
| Taxonomy Code | 207QA0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Addiction Medicine |
| A family medicine physician who specializes in the diagnosis and treatment of addictions. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) was, but is no longer issued by the American Osteopathic Board of Family Physicians. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659841880 | Dependency Medical Holdings Corporation | Family Medicine | 5600 W Bradbury Ave, Indianapolis, IN 46241 | 2018-11-30 |
| 1467824698 | Acorn Addiction Centers, LLC | Family Medicine | 1201 N Post Rd Ste 4, Indianapolis, IN 46219-4225 | 2015-10-27 |
| 1134306947 | Gerald Paul Myers | Family Medicine | 3 Park Row, Michigan City, IN 46360 | 2008-01-23 |
| 1043383680 | The Kolbe Center | Family Medicine | 1803 Broad Ripple Ave, Indianapolis, IN 46220-2339 | 2006-11-15 |
| 1336211481 | Midwest Integrated Health Systems, P.C. | Family Medicine | 3300 W 15th Ave, Gary, IN 46404-1963 | 2006-11-14 |
| 1235209156 | Elmo Allen Griggs | Family Medicine | 2811 Washington Ave, Bedford, IN 47421-5310 | 2006-11-08 |
| 1194719757 | Lawrence Hastings Schoch | Family Medicine | 2580 Michigan Rd, Suite 2, Madison, IN 47250-2491 | 2005-09-09 |
| 1609340983 | Nwi Behavioral & Addiction Medicine LLC | Family Medicine | 7805 Taft St, Merrillville, IN 46410-5233 | 2019-01-19 |
| 1134690258 | Serenity Primary Care & Recovery LLC | Family Medicine | 2708 Paoli Pike Ste I, New Albany, IN 47150-5100 | 2018-12-16 |
| 1215411020 | Stellhorn Wellness, LLC | Family Medicine | 3464 Stellhorn Rd, Fort Wayne, IN 46815-4630 | 2018-09-18 |
| Find all providers with the same taxonomy | ||||
| City | SOUTH BEND |
| Zip Code | 46619 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.