Provider Demographics
NPI:1225308562
Name:VICTORY DLC HOMECARE
Entity Type:Organization
Organization Name:VICTORY DLC HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEIDRE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHAPPELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-593-9790
Mailing Address - Street 1:872 CASCADE XING SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-8363
Mailing Address - Country:US
Mailing Address - Phone:404-696-7000
Mailing Address - Fax:404-696-7099
Practice Address - Street 1:872 CASCADE XING SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-8363
Practice Address - Country:US
Practice Address - Phone:404-696-7000
Practice Address - Fax:404-696-7099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health