Provider Demographics
NPI:1699393744
Name:VICTORY HEALTH CARE SERVICES LLC
Entity Type:Organization
Organization Name:VICTORY HEALTH CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BODE
Authorized Official - Middle Name:
Authorized Official - Last Name:AKADRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-204-5144
Mailing Address - Street 1:5808 YORK RD FL 2
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-3624
Mailing Address - Country:US
Mailing Address - Phone:443-204-5144
Mailing Address - Fax:410-617-8478
Practice Address - Street 1:5808 YORK RD FL 2
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-3624
Practice Address - Country:US
Practice Address - Phone:443-204-5144
Practice Address - Fax:410-617-8478
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VICTORY HEALTH CARE SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0812XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, CommunityGroup - Multi-Specialty