Healthcare Provider Details

I. General information

NPI: 1316429137
Provider Name (Legal Business Name): VICTOR TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22632 E RIDGE TRAIL DR
AURORA CO
80016-2698
US

IV. Provider business mailing address

22632 E RIDGE TRAIL DR
AURORA CO
80016-2698
US

V. Phone/Fax

Practice location:
  • Phone: 720-343-0363
  • Fax: 720-770-0267
Mailing address:
  • Phone: 720-343-0363
  • Fax: 720-770-0267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: IRINA SENATOROVA
Title or Position: MANAGER
Credential:
Phone: 720-343-0363