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General NPI Number Information
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NPI Number | 1356766729
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Entity Type | Organization
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Legal Business Name | VICTORY HOME CARE PRIVATE DUTY, LLC
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Dates
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Enumeration Date | 02/21/2014
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Last Update Date | 04/24/2023
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Provider Practice Location Address
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Address Line | 14999 TELEGRAPH RD
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City | REDFORD
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State | MI
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Zip | 48239-3456
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Country | US
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Telephone | 313-535-3500
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Fax | 313-766-4080
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Provider Business Mailing Address
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Address Line | PO BOX 40645
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City | REDFORD
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State | MI
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Zip | 48240-0645
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Country | US
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Telephone | 313-535-3500
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Fax | 313-766-4080
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. CALLISTA CHINWE UGORJI
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Credential | MBA
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Telephone | 313-535-3500
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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 |
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License Number State |
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