Provider Demographics
NPI:1518208222
Name:ADONAI VICTORY HEALTH SERVICES
Entity Type:Organization
Organization Name:ADONAI VICTORY HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANASTASIA
Authorized Official - Middle Name:CHINYERE
Authorized Official - Last Name:EZEIGBO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:980-272-9046
Mailing Address - Street 1:8320 UNIVERSITY EXECUTIVE PARK DRIVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262
Mailing Address - Country:US
Mailing Address - Phone:980-272-9046
Mailing Address - Fax:980-498-1778
Practice Address - Street 1:8320 UNIVERSITY EXEC PARK DR
Practice Address - Street 2:SUITE 108
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-1338
Practice Address - Country:US
Practice Address - Phone:980-272-9046
Practice Address - Fax:980-498-1778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-05
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WH0200X, 163WI0500X, 164W00000X, 225100000X, 225X00000X, 235Z00000X, 251E00000X, 372500000X, 372600000X, 374U00000X, 376K00000X
NCHC3794251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251J00000XAgenciesNursing CareGroup - Multi-Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty