Provider Demographics
NPI:1598451924
Name:VICTORY HEALTHCARE CORPORATION
Entity Type:Organization
Organization Name:VICTORY HEALTHCARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANALES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:305-394-6004
Mailing Address - Street 1:12985 SW 130TH CT STE 102-8
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5312
Mailing Address - Country:US
Mailing Address - Phone:305-394-6004
Mailing Address - Fax:305-394-6005
Practice Address - Street 1:12985 SW 130TH CT STE 102-8
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5312
Practice Address - Country:US
Practice Address - Phone:305-394-6004
Practice Address - Fax:305-394-6005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care