Provider Demographics
NPI:1841549763
Name:VICTORIOUS HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:VICTORIOUS HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IYABODE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:ONAMUTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-292-1461
Mailing Address - Street 1:9116 CENTER ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-5458
Mailing Address - Country:US
Mailing Address - Phone:571-292-1461
Mailing Address - Fax:571-292-2196
Practice Address - Street 1:9116 CENTER ST
Practice Address - Street 2:SUITE 206
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-5458
Practice Address - Country:US
Practice Address - Phone:571-292-1461
Practice Address - Fax:571-292-2196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health