MEDICARE: VICTORIOUS HEALTH SERVICES

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	251E00000X	Home Health Agency
2	251J00000X	Nursing Care Agency
3	313M00000X	Nursing Facility/Intermediate Care Facility	HC2479	NC
4	385H00000X	Respite Care
5	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578621264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICTORIOUS HEALTH SERVICES

Provider Business Mailing Address
First Line	:	2332 BEATTIES FORD RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-4314
Country	:	US
Telephone Number	:	704-535-0995
Fax Number	:	704-536-4373

Provider Business Practice Location Address
First Line	:	2332 BEATTIES FORD RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-4314
Country	:	US
Telephone Number	:	704-535-0995
Fax Number	:	704-536-4373

Authorized Official
Title or Position	:	DIRECTOR / ADMINISTRATOR
Name	:	CYPRIAN IKE IFEDI
Credential	:
Telephone Number	:	704-535-0995

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	05/27/2022

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Directions to “VICTORIOUS HEALTH SERVICES ” Practice Location

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