| Victor Community Support Services, High Desert | |
|
15095 Amargosa Rd Ste 201&208 Victorville CA 92394-1879 | |
| (760) 245-4695 | |
| (760) 780-4005 |
| Full Name | Victor Community Support Services, High Desert |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 15095 Amargosa Rd Ste 201&208, Victorville, California |
| Authorized Official Name and Position | Angie R Wiechert (DIRECTOR OF FINANCIAL ANLYSIS) |
| Authorized Official Contact | 5302301210 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Victor Community Support Services, High Desert 1360 E Lassen Ave Chico CA 95973-7823 Ph: (530) 893-0758 | Victor Community Support Services, High Desert 15095 Amargosa Rd Ste 201&208 Victorville CA 92394-1879 Ph: (760) 245-4695 |
| NPI Number | 1629120498 |
|---|---|
| Provider Enumeration Date | 01/18/2007 |
| Last Update Date | 01/29/2023 |
| Certification Date | 01/29/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629120498 | NPI | - | NPPES |
| 01042 | Other | CA | LEGAL ENTITY # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (California) | Secondary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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