Provider Demographics
NPI:1427334150
Name:VICTORY HONE HEALTH OF TEXAS
Entity type:Organization
Organization Name:VICTORY HONE HEALTH OF TEXAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINSRTATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:BOLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-868-0230
Mailing Address - Street 1:809 GALLAGHER DR STE D
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-1754
Mailing Address - Country:US
Mailing Address - Phone:903-868-0230
Mailing Address - Fax:903-868-0207
Practice Address - Street 1:301 W SAM RAYBURN DR
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-4237
Practice Address - Country:US
Practice Address - Phone:903-583-3562
Practice Address - Fax:903-583-8636
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VICTORY HOME HEALTH AND HOSPICE OF TEXAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011510251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health