Provider Demographics
NPI:1528281433
Name:VICTORY FIVE HEALTHCARE INC
Entity type:Organization
Organization Name:VICTORY FIVE HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ASHRUF
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-239-1243
Mailing Address - Street 1:2323 W ROCHELLE RD
Mailing Address - Street 2:7 SUITES # B
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-7050
Mailing Address - Country:US
Mailing Address - Phone:972-258-0527
Mailing Address - Fax:972-258-0525
Practice Address - Street 1:2323 W ROCHELLE RD
Practice Address - Street 2:7 SUITES # B
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-7050
Practice Address - Country:US
Practice Address - Phone:972-258-0527
Practice Address - Fax:972-258-0525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No171WV0202XOther Service ProvidersContractorVehicle ModificationsGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX014922OtherDADS HCSSA LICENSE
TX323803201Medicaid