Provider Demographics
NPI:1962032995
Name:VICTORIOUS MENTAL HEALTHCARE LLC
Entity Type:Organization
Organization Name:VICTORIOUS MENTAL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BOSEDE
Authorized Official - Middle Name:OLUWATOYIN
Authorized Official - Last Name:ADETUNJI - IDOWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-540-0338
Mailing Address - Street 1:5006 BELAIR RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-5101
Mailing Address - Country:US
Mailing Address - Phone:443-540-0338
Mailing Address - Fax:
Practice Address - Street 1:5006 BELAIR RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-5101
Practice Address - Country:US
Practice Address - Phone:443-540-0338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health