Provider Demographics
NPI:1790424539
Name:VICTORIOUS HOME CARE AGENCY INC
Entity Type:Organization
Organization Name:VICTORIOUS HOME CARE AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:CHIKAODINAKA
Authorized Official - Last Name:EBIRINGAH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:815-464-9201
Mailing Address - Street 1:414 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-1739
Mailing Address - Country:US
Mailing Address - Phone:815-464-9201
Mailing Address - Fax:815-464-9202
Practice Address - Street 1:414 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-1739
Practice Address - Country:US
Practice Address - Phone:815-464-9201
Practice Address - Fax:815-464-9202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty