Provider Demographics
NPI:1417348590
Name:VICTORY HOME HEALTH SERVICE INC.,
Entity Type:Organization
Organization Name:VICTORY HOME HEALTH SERVICE INC.,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LATONYA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-908-4667
Mailing Address - Street 1:3450 PALENCIA DR APT 2113
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-1857
Mailing Address - Country:US
Mailing Address - Phone:909-908-4667
Mailing Address - Fax:
Practice Address - Street 1:3450 PALENCIA DR APT 2113
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-1857
Practice Address - Country:US
Practice Address - Phone:909-908-4667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health