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Organization
VICTORY GENTLECARE AGENCY LLC
Active
Organization
VICTORY GENTLECARE AGENCY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CELESTINA DURU (ADMINISTRATOR)
(469) 766-1659
Entity
Organization
Contact information
Practice address
115 MELBOURNE RD, HURST, TX 76053-6318
(682) 227-2406
Mailing address
115 MELBOURNE RD, HURST, TX 76053-6318
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
251E00000X
Home Health Agency
Primary
—
—
3140N1450X
Pediatric Skilled Nursing Facility
—
—
3747A0650X
Attendant Care Provider
—
—
Other
Enumeration date
07/12/2024
Last updated
07/12/2024
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