Provider Demographics
NPI:1417199712
Name:A VICTORIOUS HOME CARE
Entity Type:Organization
Organization Name:A VICTORIOUS HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IKE
Authorized Official - Middle Name:
Authorized Official - Last Name:IFEDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-535-0995
Mailing Address - Street 1:3549 N SHARON AMITY RD STE 301
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-2975
Mailing Address - Country:US
Mailing Address - Phone:704-535-0995
Mailing Address - Fax:704-536-4373
Practice Address - Street 1:135 CABARRUS AVE E
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-3469
Practice Address - Country:US
Practice Address - Phone:704-865-0718
Practice Address - Fax:704-865-0720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3794251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health