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NPI Code Detail

MEDICARE: VICTORY HOME CARE CORP

MEDICARE: VICTORY HOME CARE CORP
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
1251E00000XHome Health Agency8058-PCSNV

General Provider Information

NPI Number : 1720451966
Entity Type Code : Organization
Provider Name (Legal Business Name) : VICTORY HOME CARE CORP
Provider Business Mailing Address
First Line : 9159 W FLAMINGO RD STE 103
Second Line :
City : LAS VEGAS
State : NV
Zip : 89147-6454
Country : US
Telephone Number : 702-265-1100
Fax Number : 702-998-6219
Provider Business Practice Location Address
First Line : 9159 W FLAMINGO RD STE 103
Second Line :
City : LAS VEGAS
State : NV
Zip : 89147-6454
Country : US
Telephone Number : 702-265-1100
Fax Number : 702-998-6219
Authorized Official
Title or Position : DIRECTOR
Name : TEZERA HAILE
Credential :
Telephone Number : 702-265-1100
Provider Enumeration Date : 11/10/2015
Last Update Date : 11/10/2015

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Directions to “VICTORY HOME CARE CORP ” Practice Location

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