Healthcare Provider Details

I. General information

NPI: 1427739770
Provider Name (Legal Business Name): VICTORY HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 11/14/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1582 POINT DOUGLAS RD S
SAINT PAUL MN
55119-6006
US

IV. Provider business mailing address

1582 POINT DOUGLAS RD S
SAINT PAUL MN
55119-6006
US

V. Phone/Fax

Practice location:
  • Phone: 651-398-5708
  • Fax:
Mailing address:
  • Phone: 651-398-5708
  • Fax:

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 Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: YILLAH ELI KARGBO
Title or Position: DIRECTOR OF NURSING
Credential:
Phone: 651-398-5708