Healthcare Provider Details

I. General information

NPI: 1104698687
Provider Name (Legal Business Name): VICTOBA HEALTHCARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2023
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21030 KADEFIELD DR
CYPRESS TX
77433-8343
US

IV. Provider business mailing address

21030 KADEFIELD DR
CYPRESS TX
77433-8343
US

V. Phone/Fax

Practice location:
  • Phone: 713-835-5860
  • Fax:
Mailing address:
  • Phone: 713-835-5860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: OBARO BLESSING EBIBOKEFIE
Title or Position: ADMINISTRATOR/DIRECTOR/PRESIDENT
Credential: RN
Phone: 713-835-5860