Provider Demographics
NPI:1932573375
Name:VICTORY HOUSE CALLS
Entity Type:Organization
Organization Name:VICTORY HOUSE CALLS
Other - Org Name:VICTORY HOUSE CALLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MILLICENT
Authorized Official - Middle Name:C
Authorized Official - Last Name:ADIKAIBE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:281-451-0198
Mailing Address - Street 1:6519 BRIARGATE TRAILS
Mailing Address - Street 2:
Mailing Address - City:MISSOURI
Mailing Address - State:TX
Mailing Address - Zip Code:77489
Mailing Address - Country:US
Mailing Address - Phone:281-451-0198
Mailing Address - Fax:281-438-4420
Practice Address - Street 1:6519 BRIARGATE TRAILS
Practice Address - Street 2:
Practice Address - City:MISSOURI
Practice Address - State:TX
Practice Address - Zip Code:77489
Practice Address - Country:US
Practice Address - Phone:281-451-0198
Practice Address - Fax:281-438-4420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126128363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty