Provider Demographics
NPI:1205618964
Name:VICTORIOUS FAMILY CARE CENTER
Entity type:Organization
Organization Name:VICTORIOUS FAMILY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TONISHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-281-4787
Mailing Address - Street 1:2840 SUMMER OAKS DR STE 102
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-3854
Mailing Address - Country:US
Mailing Address - Phone:901-578-8418
Mailing Address - Fax:
Practice Address - Street 1:2840 SUMMER OAKS DR STE 102
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-3854
Practice Address - Country:US
Practice Address - Phone:901-578-8418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty