Provider Demographics
NPI:1487494753
Name:VICTORY TREATMENT GROUP LLC
Entity type:Organization
Organization Name:VICTORY TREATMENT GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:SCICCHITANO
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:570-898-5072
Mailing Address - Street 1:2362 STETLER DR
Mailing Address - Street 2:
Mailing Address - City:COAL TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:17866-1677
Mailing Address - Country:US
Mailing Address - Phone:570-898-5072
Mailing Address - Fax:
Practice Address - Street 1:615 N SHAMOKIN ST
Practice Address - Street 2:
Practice Address - City:SHAMOKIN
Practice Address - State:PA
Practice Address - Zip Code:17872-6719
Practice Address - Country:US
Practice Address - Phone:570-898-5072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-25
Last Update Date:2024-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder