Provider Demographics
NPI:1093582298
Name:JC VICTORY HEALTH LLC
Entity Type:Organization
Organization Name:JC VICTORY HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSY
Authorized Official - Middle Name:
Authorized Official - Last Name:CECIL
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:832-729-2461
Mailing Address - Street 1:445 MURPHY RD STE 101B-1
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-5453
Mailing Address - Country:US
Mailing Address - Phone:832-729-1461
Mailing Address - Fax:832-539-1448
Practice Address - Street 1:445 MURPHY RD STE 101B-1
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-5453
Practice Address - Country:US
Practice Address - Phone:832-729-1461
Practice Address - Fax:832-539-1448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty