MEDICARE: VICTORY MISSION CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator	438444	TX

General Provider Information

NPI Number	:	1114041365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICTORY MISSION CENTER

Provider Business Mailing Address
First Line	:	6420 HILLCROFT ST
Second Line	:	SUITE 303
City	:	HOUSTON
State	:	TX
Zip	:	77081-3190
Country	:	US
Telephone Number	:	713-270-4800
Fax Number	:	713-789-9619

Provider Business Practice Location Address
First Line	:	6420 HILLCROFT ST
Second Line	:	SUITE 303
City	:	HOUSTON
State	:	TX
Zip	:	77081-3190
Country	:	US
Telephone Number	:	713-270-4800
Fax Number	:	713-789-9619

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	VERONICA EBIE
Credential	:
Telephone Number	:	713-270-4800

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	08/22/2020

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Directions to “VICTORY MISSION CENTER ” Practice Location

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