MEDICARE: D' VICTORY HOSPICE CARE, INC.

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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1669054516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D' VICTORY HOSPICE CARE, INC.

Provider Business Mailing Address
First Line	:	23318 OLIVE WOOD PLAZA DR STE G
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92553-5219
Country	:	US
Telephone Number	:	951-267-7660
Fax Number	:	951-220-8619

Provider Business Practice Location Address
First Line	:	23318 OLIVE WOOD PLAZA DR STE G
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92553-5219
Country	:	US
Telephone Number	:	951-267-7660
Fax Number	:	951-220-8619

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	BERNICE IVOKO
Credential	:
Telephone Number	:	951-267-7660

Provider Enumeration Date	:	04/21/2021
Last Update Date	:	04/21/2021

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