Healthcare Provider Details

I. General information

NPI: 1790613867
Provider Name (Legal Business Name): VICTORY WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 HARGROVE RD STE 106
RALEIGH NC
27616-1949
US

IV. Provider business mailing address

4801 HARGROVE RD STE 106
RALEIGH NC
27616-1949
US

V. Phone/Fax

Practice location:
  • Phone: 310-227-2154
  • Fax:
Mailing address:
  • Phone: 310-227-2154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: NONYE OKAFOR
Title or Position: CEO
Credential: RN
Phone: 310-227-2154