Provider Demographics
NPI:1427739770
Name:VICTORY HOME HEALTH CARE LLC
Entity type:Organization
Organization Name:VICTORY HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:YILLAH
Authorized Official - Middle Name:ELI
Authorized Official - Last Name:KARGBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-398-5708
Mailing Address - Street 1:1582 POINT DOUGLAS RD S
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55119-6006
Mailing Address - Country:US
Mailing Address - Phone:651-398-5708
Mailing Address - Fax:
Practice Address - Street 1:1582 POINT DOUGLAS RD S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55119-6006
Practice Address - Country:US
Practice Address - Phone:651-398-5708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-28
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility