VICTORY BAY RESIDENTIAL SERVICES I, LLC
NPI 1609630276
Clinic/Center - Health Service in Tarzana, CA
About Victory Bay Residential Services I, Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
VICTORY BAY RESIDENTIAL SERVICES I, LLC (NPI 1609630276) is a healthcare organization registered as a health service in Tarzana, California and active in the NPI registry since February 2024. The organization holds a CLIA Waiver certificate valid through April 17, 2028 and lists Jennifer Mellon, Director Regulatory Compliance, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 05D2302968
Victory Bay Residential Services I, LLC · Tarzana, CAFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Victory Bay Residential Services I, LLC's NPI number?
The NPI number for Victory Bay Residential Services I, LLC is 1609630276. It was assigned to this organization in the NPPES registry on February 13, 2024.
Where is Victory Bay Residential Services I, LLC located?
Victory Bay Residential Services I, LLC is located at 19667 Trull Brook Dr, Tarzana, CA 91356. The listed phone number is (856) 282-2028.
What is Victory Bay Residential Services I, LLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Health Service, with taxonomy code 261QH0100X.
Does Victory Bay Residential Services I, LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 05D2302968) is associated with this NPI, valid through April 17, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Victory Bay Residential Services I, LLC was last updated on September 17, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Victory Bay Residential Services I, Llc · NPI 1609630276
Health Service organization in Tarzana, California. Organization record, active in the CMS NPPES registry since February 13, 2024.
## Identity
- **NPI:** 1609630276 (Entity type: Organization)
- **Enumerated:** February 13, 2024
- **Primary specialty:** Clinic/Center - Health Service · taxonomy 261QH0100X
- **Organization subpart:** No
- **Authorized official:** Jennifer Mellon, DIRECTOR REGULATORY COMPLIANCE
## Practice location
- **Address:** 19667 TRULL BROOK DR, Tarzana, CA 91356-5630
- **Phone:** (856) 282-2028
## Record status
- **NPPES last updated:** September 17, 2024
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1609630276) · Data from the CMS NPPES public registry.