Provider Demographics
NPI:1578621264
Name:VICTORIOUS HEALTH SERVICES
Entity Type:Organization
Organization Name:VICTORIOUS HEALTH SERVICES
Other - Org Name:A VICTORIOUS HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR / ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CYPRIAN
Authorized Official - Middle Name:IKE
Authorized Official - Last Name:IFEDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-535-0995
Mailing Address - Street 1:2332 BEATTIES FORD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-4314
Mailing Address - Country:US
Mailing Address - Phone:704-535-0995
Mailing Address - Fax:704-536-4373
Practice Address - Street 1:2332 BEATTIES FORD RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-4314
Practice Address - Country:US
Practice Address - Phone:704-535-0995
Practice Address - Fax:704-536-4373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251J00000X, 253Z00000X, 385H00000X
NCHC2479313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409646Medicaid
NC6601047Medicaid
NC7100596Medicaid