Provider Demographics
NPI:1023867728
Name:VICTORIA MEMORIAL HEALTHCARE, LLC
Entity type:Organization
Organization Name:VICTORIA MEMORIAL HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DNP
Authorized Official - Prefix:DR
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:O
Authorized Official - Last Name:ITABIYI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:347-876-1243
Mailing Address - Street 1:1111 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3703
Mailing Address - Country:US
Mailing Address - Phone:347-876-1243
Mailing Address - Fax:610-257-3104
Practice Address - Street 1:1111 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3703
Practice Address - Country:US
Practice Address - Phone:347-876-1243
Practice Address - Fax:610-257-3104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty