Provider Demographics
NPI:1356766729
Name:VICTORY HOME CARE PRIVATE DUTY, LLC
Entity type:Organization
Organization Name:VICTORY HOME CARE PRIVATE DUTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CALLISTA
Authorized Official - Middle Name:CHINWE
Authorized Official - Last Name:UGORJI
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:313-535-3500
Mailing Address - Street 1:PO BOX 40645
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240-0645
Mailing Address - Country:US
Mailing Address - Phone:313-535-3500
Mailing Address - Fax:313-766-4080
Practice Address - Street 1:14999 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-3456
Practice Address - Country:US
Practice Address - Phone:313-535-3500
Practice Address - Fax:313-766-4080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-21
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health