Provider Demographics
NPI:1194374389
Name:VICTRESS HEALTHCARE STAFFING SOLUTIONS
Entity Type:Organization
Organization Name:VICTRESS HEALTHCARE STAFFING SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LADAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:843-592-5088
Mailing Address - Street 1:PO BOX 1094
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-2618
Mailing Address - Country:US
Mailing Address - Phone:843-592-5088
Mailing Address - Fax:843-781-8890
Practice Address - Street 1:6646 KATO BAY RD
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-7879
Practice Address - Country:US
Practice Address - Phone:843-592-5088
Practice Address - Fax:843-781-8890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health