Provider Demographics
NPI:1124836523
Name:VICTORIOUS LLC
Entity type:Organization
Organization Name:VICTORIOUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-938-6801
Mailing Address - Street 1:3644 SHEPPERTON BLVD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46228-2962
Mailing Address - Country:US
Mailing Address - Phone:317-938-6801
Mailing Address - Fax:
Practice Address - Street 1:3644 SHEPPERTON BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46228-2962
Practice Address - Country:US
Practice Address - Phone:317-938-6801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care