Provider Demographics
NPI:1831489459
Name:VICTORY MULTICARE NURSING SERVICES, INC.
Entity Type:Organization
Organization Name:VICTORY MULTICARE NURSING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:
Authorized Official - Last Name:OKPOMO
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN
Authorized Official - Phone:770-942-8033
Mailing Address - Street 1:4350 HUNTCLIFF TRCE
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-8428
Mailing Address - Country:US
Mailing Address - Phone:770-942-8033
Mailing Address - Fax:770-942-8033
Practice Address - Street 1:4350 HUNTCLIFF TRCE
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-8428
Practice Address - Country:US
Practice Address - Phone:770-942-8033
Practice Address - Fax:770-942-8033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-15
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048-R-0836251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care