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General NPI Number Information
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NPI Number | 1114229630
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Entity Type | Organization
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Legal Business Name | VICTORY NURSING & HOME CARE, INC.
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Dates
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Enumeration Date | 12/04/2010
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Last Update Date | 06/07/2017
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Provider Practice Location Address
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Address Line | 238 S CARROLL RD
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City | VILLA RICA
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State | GA
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Zip | 30180-2625
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Country | US
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Telephone | 404-474-8900
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Fax | 404-474-1189
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Provider Business Mailing Address
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Address Line | 238 S. CARROLL RD.
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City | VILLA RICA
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State | GA
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Zip | 30180-1929
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Country | US
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Telephone | 404-474-8900
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Fax | 404-474-1189
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. LEONA N AMADI
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Credential |
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Telephone | 404-474-8900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 022-R-0503
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License Number State | GA
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