Provider Demographics
NPI:1508301185
Name:VICTORY HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:VICTORY HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:N
Authorized Official - Last Name:OKOWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-418-8225
Mailing Address - Street 1:8501 TOWER POINT DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-7849
Mailing Address - Country:US
Mailing Address - Phone:704-841-0203
Mailing Address - Fax:
Practice Address - Street 1:1519 W GARRISON BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-3671
Practice Address - Country:US
Practice Address - Phone:704-759-4225
Practice Address - Fax:980-289-1302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3021251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCHC3021Medicaid