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NPI Code Detail

MEDICARE: FROM DEFEAT 2 VICTORY, LLC

MEDICARE: FROM DEFEAT 2 VICTORY, LLC
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
1251E00000XHome Health Agency

General Provider Information

NPI Number : 1457941957
Entity Type Code : Organization
Provider Name (Legal Business Name) : FROM DEFEAT 2 VICTORY, LLC
Provider Business Mailing Address
First Line : 3422 BUSINESS CENTER DRIVE
Second Line : SUITE 106 #1132
City : PEARLAND
State : TX
Zip : 77584-4215
Country : US
Telephone Number : 512-783-2188
Fax Number : 281-603-1728
Provider Business Practice Location Address
First Line : 3422 BUSINESS CENTER DR STE 106
Second Line :
City : PEARLAND
State : TX
Zip : 77584-4159
Country : US
Telephone Number : 512-783-2188
Fax Number :
Authorized Official
Title or Position : CEO
Name : SAMONE SMITH
Credential : CNA
Telephone Number : 512-783-2188
Provider Enumeration Date : 01/19/2021
Last Update Date : 03/11/2021

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Directions to “FROM DEFEAT 2 VICTORY, LLC ” Practice Location

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