Provider Demographics
NPI:1609633080
Name:VICTORY HEALTH HOME 2 PLLC
Entity Type:Organization
Organization Name:VICTORY HEALTH HOME 2 PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:ODUTOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MBBS
Authorized Official - Phone:407-738-5791
Mailing Address - Street 1:9132 W HUBBELL ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-4377
Mailing Address - Country:US
Mailing Address - Phone:407-738-5791
Mailing Address - Fax:
Practice Address - Street 1:9132 W HUBBELL ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-4377
Practice Address - Country:US
Practice Address - Phone:407-738-5791
Practice Address - Fax:480-210-3563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness