Healthcare Provider Details

I. General information

NPI: 1609780113
Provider Name (Legal Business Name): VICTORY ONE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3614 103RD TRL N
BROOKLYN PARK MN
55443-1885
US

IV. Provider business mailing address

3614 103RD TRL N
BROOKLYN PARK MN
55443-1885
US

V. Phone/Fax

Practice location:
  • Phone: 612-703-1375
  • Fax: 612-241-3470
Mailing address:
  • Phone: 612-703-1375
  • Fax: 612-241-3470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: VICTORIA CHIGOZIE EVULEOCHA
Title or Position: NURSING
Credential: RN
Phone: 612-703-1374