Provider Demographics
NPI:1003113549
Name:VICTORY HEALTHCARE AGENCY
Entity Type:Organization
Organization Name:VICTORY HEALTHCARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:ADDO
Authorized Official - Last Name:DANSO
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:913-602-0686
Mailing Address - Street 1:10303 W 77TH ST
Mailing Address - Street 2:APT#207
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66214-1217
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:913-499-6198
Practice Address - Street 1:10303 W 77TH ST
Practice Address - Street 2:APT#207
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66214-1217
Practice Address - Country:US
Practice Address - Phone:913-602-0686
Practice Address - Fax:913-499-6198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSA046174251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health