Provider Demographics
NPI:1265528145
Name:VICTORY HOME CARE, INC
Entity type:Organization
Organization Name:VICTORY HOME CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLWELL
Authorized Official - Middle Name:
Authorized Official - Last Name:INIMGBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-566-3318
Mailing Address - Street 1:7420 UNITY AVE N
Mailing Address - Street 2:209
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-3143
Mailing Address - Country:US
Mailing Address - Phone:763-566-3318
Mailing Address - Fax:763-560-0250
Practice Address - Street 1:7420 UNITY AVE N
Practice Address - Street 2:209
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-3143
Practice Address - Country:US
Practice Address - Phone:763-566-3318
Practice Address - Fax:763-560-0250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN333944251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health