Provider Demographics
NPI:1861005035
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:MPP
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:443-529-9099
Mailing Address - Fax:
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:443-529-9099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VICTORY HEALTH CARE SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health