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General NPI Number Information
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NPI Number | 1134286784
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Entity Type | Organization
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Legal Business Name | VICTORY HEALTHCARE INC
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 02/21/2012
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Provider Practice Location Address
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Address Line | 314 W MILLBROOK RD SUITE 9
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City | RALEIGH
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State | NC
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Zip | 27609-4380
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Country | US
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Telephone | 919-846-9027
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Fax | 919-870-9263
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Provider Business Mailing Address
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Address Line | 4705 DRESDEN VLG
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City | RALEIGH
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State | NC
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Zip | 27604-4983
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Country | US
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Telephone | 919-846-9027
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Fax | 919-870-9263
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Authorized Official
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Title or Position | AGENCY DIRECTOR
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Name | MR. ERIC I ILOABACHIE
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Credential |
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Telephone | 919-846-9027
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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 | HC3446
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License Number State | NC
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