Provider Demographics
NPI:1487236071
Name:VICTORIOUS FAMILY AND NURSING HEALTHCARE SERVICES, LLC
Entity type:Organization
Organization Name:VICTORIOUS FAMILY AND NURSING HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ESHTER
Authorized Official - Middle Name:MONIE
Authorized Official - Last Name:GONGA
Authorized Official - Suffix:
Authorized Official - Credentials:HEALTHCARE AGENCY
Authorized Official - Phone:240-470-9867
Mailing Address - Street 1:14333 LAUREL BOWIE RD STE 108
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-1149
Mailing Address - Country:US
Mailing Address - Phone:240-470-9867
Mailing Address - Fax:240-470-9867
Practice Address - Street 1:14333 LAUREL BOWIE RD STE 108
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-1149
Practice Address - Country:US
Practice Address - Phone:240-470-9867
Practice Address - Fax:240-470-9867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health