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Organization
VICTORY HOME HEALTH AGENCY
Active
Organization
VICTORY HOME HEALTH AGENCY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JECINTA NKEIRUKA AZONOBI LVN (ASSISTANT ADMINISTRATOR)
(951) 924-5114
Entity
Organization
Contact information
Practice address
24490 SUNNYMEAD BLVD STE 108, MORENO VALLEY, CA 92553-7762
(951) 924-5114
(951) 924-5182
Mailing address
24490 SUNNYMEAD BLVD STE 108, MORENO VALLEY, CA 92553-7762
(951) 924-5114
(951) 924-5182
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
HHA08190F
—
CA
Enumeration date
01/03/2007
Last updated
08/22/2020
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