Provider Demographics
NPI:1548433840
Name:VICTORY THROUGH FAITH RECOVERY SERVICES
Entity type:Organization
Organization Name:VICTORY THROUGH FAITH RECOVERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:WARDEL
Authorized Official - Last Name:LOCKETT
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:612-827-0484
Mailing Address - Street 1:3047 5TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2415
Mailing Address - Country:US
Mailing Address - Phone:612-827-0484
Mailing Address - Fax:612-827-0485
Practice Address - Street 1:3047 5TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2415
Practice Address - Country:US
Practice Address - Phone:612-827-0484
Practice Address - Fax:612-827-0485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1009414324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility