Provider Demographics
NPI:1194852251
Name:VICTORY HOSPICE OF TEXAS, LLC
Entity Type:Organization
Organization Name:VICTORY HOSPICE OF TEXAS, LLC
Other - Org Name:VICTORY HOSPICE OF TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:OCHOA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-458-9012
Mailing Address - Street 1:3900 JOE RAMSEY BLVD E
Mailing Address - Street 2:BLDG. #4, SUITE C
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-7727
Mailing Address - Country:US
Mailing Address - Phone:903-458-9012
Mailing Address - Fax:855-710-7022
Practice Address - Street 1:3900 JOE RAMSEY BLVD E
Practice Address - Street 2:BLDG. #4, SUITE C
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7727
Practice Address - Country:US
Practice Address - Phone:903-458-9012
Practice Address - Fax:855-710-7022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011512251G00000X
TX251G00000X
TX011510251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1016159Medicaid
TX1016159Medicaid