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General NPI Number Information
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NPI Number | 1003113549
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Entity Type | Organization
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Legal Business Name | VICTORY HEALTHCARE AGENCY
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Dates
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Enumeration Date | 02/18/2011
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Last Update Date | 02/18/2011
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Provider Practice Location Address
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Address Line | 10303 W 77TH ST APT#207
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City | SHAWNEE
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State | KS
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Zip | 66214-1217
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Country | US
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Telephone | 913-602-0686
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Fax | 913-499-6198
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Provider Business Mailing Address
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Address Line | 10303 W 77TH ST APT#207
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City | SHAWNEE
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State | KS
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Zip | 66214-1217
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Country | US
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Telephone |
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Fax | 913-499-6198
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. SAMUEL ADDO DANSO
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Credential | BSN, RN
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Telephone | 913-602-0686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | A046174
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License Number State | KS
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