Provider Demographics
NPI:1508137548
Name:HOUSE OF VICTORY
Entity Type:Organization
Organization Name:HOUSE OF VICTORY
Other - Org Name:HOUSE OF VICTORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALERIA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-569-0288
Mailing Address - Street 1:2819 AINWICK CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-6720
Mailing Address - Country:US
Mailing Address - Phone:469-569-0288
Mailing Address - Fax:
Practice Address - Street 1:2819 AINWICK CT
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-6720
Practice Address - Country:US
Practice Address - Phone:469-569-0288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
310400000X
TX3104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness