MEDICARE: VICTORY WELLNESS 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
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1790613867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICTORY WELLNESS LLC

Provider Business Mailing Address
First Line	:	4801 HARGROVE RD STE 106
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616-1949
Country	:	US
Telephone Number	:	310-227-2154
Fax Number	:

Provider Business Practice Location Address
First Line	:	4801 HARGROVE RD STE 106
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616-1949
Country	:	US
Telephone Number	:	310-227-2154
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	NONYE OKAFOR
Credential	:	RN
Telephone Number	:	310-227-2154

Provider Enumeration Date	:	05/11/2026
Last Update Date	:	05/11/2026

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Directions to “VICTORY WELLNESS LLC ” Practice Location

Language	Start Address	Practice Location

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