Provider Demographics
NPI:1770181679
Name:VICTORY HOMES LLC
Entity Type:Organization
Organization Name:VICTORY HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SONIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KPANAKU
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, PHN
Authorized Official - Phone:763-321-1278
Mailing Address - Street 1:7917 PERRY AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-2418
Mailing Address - Country:US
Mailing Address - Phone:763-321-1278
Mailing Address - Fax:888-349-5754
Practice Address - Street 1:7917 PERRY AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-2418
Practice Address - Country:US
Practice Address - Phone:763-321-1278
Practice Address - Fax:888-349-5754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-13
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251J00000XAgenciesNursing Care