Provider Demographics
NPI:1407294374
Name:VICTORY PROFESSIONAL GROUP INC
Entity Type:Organization
Organization Name:VICTORY PROFESSIONAL GROUP INC
Other - Org Name:GOLD CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-866-2345
Mailing Address - Street 1:7007 GULF FWY STE 222A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77087-2503
Mailing Address - Country:US
Mailing Address - Phone:832-866-2345
Mailing Address - Fax:713-981-1811
Practice Address - Street 1:7007 GULF FWY STE 222A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-2503
Practice Address - Country:US
Practice Address - Phone:832-866-2345
Practice Address - Fax:713-981-1811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health