Healthcare Provider Details

I. General information

NPI: 1730831694
Provider Name (Legal Business Name): VICTORIA CARE MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2022
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11936 N COMMUNITY HOUSE RD
CHARLOTTE NC
28277-4978
US

IV. Provider business mailing address

5700 RYDER AVE
CHARLOTTE NC
28226-8304
US

V. Phone/Fax

Practice location:
  • Phone: 919-904-8524
  • Fax:
Mailing address:
  • Phone: 191-990-4842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: TAMUNOTONYE FIABEMA
Title or Position: CEO
Credential: RN
Phone: 919-904-8524