Healthcare Provider Details

I. General information

NPI: 1669139762
Provider Name (Legal Business Name): VICTORIA GARDEN HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 MOSS BANK DR
LAUREL MD
20724-2932
US

IV. Provider business mailing address

8001 MOSS BANK DR
LAUREL MD
20724-2932
US

V. Phone/Fax

Practice location:
  • Phone: 301-509-0739
  • Fax:
Mailing address:
  • Phone: 301-509-0739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: YETUNDE OTUBANJO
Title or Position: PROVIDER
Credential:
Phone: 301-509-0739