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General NPI Number Information
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NPI Number | 1720451966
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Entity Type | Organization
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Legal Business Name | VICTORY HOME CARE CORP
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Dates
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Enumeration Date | 11/10/2015
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Last Update Date | 11/10/2015
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Provider Practice Location Address
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Address Line | 9159 W FLAMINGO RD STE 103
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City | LAS VEGAS
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State | NV
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Zip | 89147-6454
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Country | US
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Telephone | 702-265-1100
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Fax | 702-998-6219
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Provider Business Mailing Address
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Address Line | 9159 W FLAMINGO RD STE 103
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City | LAS VEGAS
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State | NV
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Zip | 89147-6454
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Country | US
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Telephone | 702-265-1100
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Fax | 702-998-6219
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Authorized Official
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Title or Position | DIRECTOR
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Name | TEZERA HAILE
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Credential |
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Telephone | 702-265-1100
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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 | 8058-PCS
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License Number State | NV
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