Healthcare Provider Details

I. General information

NPI: 1205485588
Provider Name (Legal Business Name): VICTORY HEALTH CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 12/10/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E NORTHERN PKWY STE 205207
BALTIMORE MD
21239-2113
US

IV. Provider business mailing address

1900 E .NORTHERN PARK WAY SUITE205-207
BALTIMORE MD
21239-4225
US

V. Phone/Fax

Practice location:
  • Phone: 443-204-5144
  • Fax: 410-617-8478
Mailing address:
  • Phone: 443-529-9099
  • Fax: 410-617-8478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. BODE AKADRI
Title or Position: DIRECTOR
Credential: MPP
Phone: 443-529-9099