Healthcare Provider Details

I. General information

NPI: 1811818222
Provider Name (Legal Business Name): VICTRESS HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 E 4TH ST
LIMA OH
45804-4172
US

IV. Provider business mailing address

2025 E 4TH ST STE D
LIMA OH
45804-4172
US

V. Phone/Fax

Practice location:
  • Phone: 937-557-5657
  • Fax: 513-230-2024
Mailing address:
  • Phone: 937-557-5657
  • Fax: 513-230-2024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIN E HAZELBAKER
Title or Position: CEO/OWNER
Credential: PT
Phone: 937-266-5900