Healthcare Provider Details

I. General information

NPI: 1871195925
Provider Name (Legal Business Name): VICTORY AT HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2020
Last Update Date: 01/18/2025
Certification Date: 01/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 N WISCONSIN ST
HOBART IN
46342-2160
US

IV. Provider business mailing address

409 N WISCONSIN ST
HOBART IN
46342-2160
US

V. Phone/Fax

Practice location:
  • Phone: 219-806-5383
  • Fax:
Mailing address:
  • Phone: 219-806-5383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MISS REGINA MARIE BEARD
Title or Position: CEO
Credential: MSN, RN
Phone: 219-806-5383