Provider Demographics
NPI:1538310321
Name:VICTORY HOME HEALTH CARE
Entity Type:Organization
Organization Name:VICTORY HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LUCIA
Authorized Official - Middle Name:CAROLINA
Authorized Official - Last Name:MONTEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-797-9544
Mailing Address - Street 1:5326 CHESNUT VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SAN
Mailing Address - State:TX
Mailing Address - Zip Code:78247-5000
Mailing Address - Country:US
Mailing Address - Phone:210-797-9544
Mailing Address - Fax:210-848-3048
Practice Address - Street 1:5326 CHESNUT VIEW DR
Practice Address - Street 2:
Practice Address - City:SAN
Practice Address - State:TX
Practice Address - Zip Code:78247-5000
Practice Address - Country:US
Practice Address - Phone:210-797-9544
Practice Address - Fax:210-848-3048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122220320800000X, 323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness