Provider Demographics
NPI:1689835035
Name:VICTORIA CARE LLC
Entity Type:Organization
Organization Name:VICTORIA CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/ ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:MAGPANTAY
Authorized Official - Last Name:MENESES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:650-544-3307
Mailing Address - Street 1:2155 WOODSIDE RD
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-1144
Mailing Address - Country:US
Mailing Address - Phone:650-544-3307
Mailing Address - Fax:650-368-9363
Practice Address - Street 1:2155 WOODSIDE RD
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-1144
Practice Address - Country:US
Practice Address - Phone:650-544-3307
Practice Address - Fax:650-368-9363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25363251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health