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General NPI Number Information
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NPI Number | 1619287802
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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 | 10/20/2010
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Last Update Date | 10/20/2010
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Provider Practice Location Address
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Address Line | 343 TICHENOR AVE
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City | SOUTH ORANGE
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State | NJ
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Zip | 07079-2116
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Country | US
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Telephone | 201-341-4051
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Fax | 973-327-4643
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Provider Business Mailing Address
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Address Line | 343 TICHENOR AVE
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City | SOUTH ORANGE
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State | NJ
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Zip | 07079-2116
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Country | US
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Telephone | 201-341-4051
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Fax | 973-327-4643
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. DORIS NONYEREM OKEREKE
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Credential |
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Telephone | 201-341-4051
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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 | 26NR07390500
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License Number State | NJ
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