Provider Demographics
NPI:1073251328
Name:GREAT VICTORY CARE LLC
Entity Type:Organization
Organization Name:GREAT VICTORY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOSES
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEJOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-353-5656
Mailing Address - Street 1:2304 SENATOR AVE
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-3354
Mailing Address - Country:US
Mailing Address - Phone:240-353-5656
Mailing Address - Fax:
Practice Address - Street 1:2304 SENATOR AVE
Practice Address - Street 2:
Practice Address - City:DISTRICT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20747-3354
Practice Address - Country:US
Practice Address - Phone:240-353-5656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health