MEDICARE: A VICTORY HEALTH CARE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency		FL

General Provider Information

NPI Number	:	1215981857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A VICTORY HEALTH CARE, INC

Provider Business Mailing Address
First Line	:	6447 MIAMI LAKES DR E
Second Line	:	222 F
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2741
Country	:	US
Telephone Number	:	305-820-8777
Fax Number	:	305-698-9070

Provider Business Practice Location Address
First Line	:	6447 MIAMI LAKES DR E
Second Line	:	222 F
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2741
Country	:	US
Telephone Number	:	305-820-8777
Fax Number	:	305-698-9070

Authorized Official
Title or Position	:	DON
Name	:	MRS. ESTHER M DIAZ
Credential	:	R.N.
Telephone Number	:	305-820-8777

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	08/22/2020

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