1407040785 NPI number — VICTORY HEALTHCARE SERVICES, INC

Table of content: (NPI 1407040785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407040785 NPI number — VICTORY HEALTHCARE SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VICTORY HEALTHCARE SERVICES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407040785
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 20738
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27619-0738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-376-8521
Provider Business Mailing Address Fax Number:
919-803-1149

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3716 SUMMER PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27604-4252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-376-8521
Provider Business Practice Location Address Fax Number:
919-803-1149
Provider Enumeration Date:
08/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
IRONA
Authorized Official First Name:
CHRIS
Authorized Official Middle Name:
ADIEWERE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
919-376-8521

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com