1427334150 NPI number — VICTORY HONE HEALTH OF TEXAS

Table of content: (NPI 1427334150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427334150 NPI number — VICTORY HONE HEALTH OF TEXAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VICTORY HONE HEALTH OF TEXAS
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:
VICTORY HOME HEALTH & HOSPICE OF TEXAS
Provider Other Organization Name Type Code:
5
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:
1427334150
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
809 GALLAGHER DR STE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHERMAN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75090-1754
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-868-0230
Provider Business Mailing Address Fax Number:
903-868-0207

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 W SAM RAYBURN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BONHAM
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75418-4237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-583-3562
Provider Business Practice Location Address Fax Number:
903-583-8636
Provider Enumeration Date:
10/26/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BOLEN
Authorized Official First Name:
JUDY
Authorized Official Middle Name:
K
Authorized Official Title or Position:
ADMINSRTATOR
Authorized Official Telephone Number:
903-868-0230

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  011510 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com