MEDICARE: VICTORY HOME HEALTH CARE

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	320800000X	Mental Illness Community Based Residential Treatment Facility	122220	TX
2	323P00000X	Psychiatric Residential Treatment Facility	122220	TX

General Provider Information

NPI Number	:	1538310321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICTORY HOME HEALTH CARE

Provider Business Mailing Address
First Line	:	5326 CHESNUT VIEW DR
Second Line	:
City	:	SAN
State	:	TX
Zip	:	78247-5000
Country	:	US
Telephone Number	:	210-797-9544
Fax Number	:	210-848-3048

Provider Business Practice Location Address
First Line	:	5326 CHESNUT VIEW DR
Second Line	:
City	:	SAN
State	:	TX
Zip	:	78247-5000
Country	:	US
Telephone Number	:	210-797-9544
Fax Number	:	210-848-3048

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. LUCIA CAROLINA MONTEZ
Credential	:
Telephone Number	:	210-797-9544

Provider Enumeration Date	:	10/10/2008
Last Update Date	:	10/10/2008

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Directions to “VICTORY HOME HEALTH CARE ” Practice Location

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