# VICTORY WELLNESS CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** VICTORY WELLNESS CENTER, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255662516
- **Authorized official:** SUPORIOR R HARRIS CRNP (C.E.O./ CERTIFIED NURSE PRACTITIONE)
- **Authorized official phone:** (251) 610-2644

## Contact information

- **Practice address:** 123 CAILLAVET ST, BILOXI, MS 39530-4101
- **Practice address phone:** (228) 386-7487
- **Practice address fax:** (228) 386-7499
- **Mailing address:** PO BOX 8556, BILOXI, MS 39535-8556
- **Mailing address phone:** (251) 610-2644
- **Mailing address fax:** (251) 639-9707

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | R866985 | MS | Yes |

## Other

- **Enumeration date:** 01/26/2010
- **Last updated:** 01/26/2010