Provider Demographics
NPI:1790842177
Name:VICTORYHOMEHEALTHANDHOSPICE20
Entity Type:Organization
Organization Name:VICTORYHOMEHEALTHANDHOSPICE20
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NOAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-621-2290
Mailing Address - Street 1:155 BENNETT RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-8822
Mailing Address - Country:US
Mailing Address - Phone:662-645-2290
Mailing Address - Fax:662-621-2290
Practice Address - Street 1:155 BENNETT RD
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-8822
Practice Address - Country:US
Practice Address - Phone:662-645-2290
Practice Address - Fax:662-621-2290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based