Provider Demographics
NPI:1174990162
Name:VICTORY COMMUNITY SERVICES, INC.
Entity type:Organization
Organization Name:VICTORY COMMUNITY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:AMAECHI
Authorized Official - Last Name:MINIKWU
Authorized Official - Suffix:SR
Authorized Official - Credentials:CMHP, CPP
Authorized Official - Phone:305-974-5299
Mailing Address - Street 1:20535 NW 2ND AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-2547
Mailing Address - Country:US
Mailing Address - Phone:305-974-5299
Mailing Address - Fax:786-320-6026
Practice Address - Street 1:20535 NW 2ND AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-2547
Practice Address - Country:US
Practice Address - Phone:305-974-5299
Practice Address - Fax:786-320-6026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL012287100253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012287100Medicaid