# VICTORIOUS HEALTHCARE L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912455361
- **Authorized official:** MS. MARY JEAN BEN (C.E. O.)
- **Authorized official phone:** (601) 209-4278

## Contact information

- **Practice address:** 4959 LAUREL OAK DR, JACKSON, MS 39212-2150
- **Practice address phone:** (601) 209-4278
- **Mailing address:** 4959 LAUREL OAK DR, JACKSON, MS 39212-2150
- **Mailing address phone:** (601) 209-4278

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | — | NULL | — |
| 311ZA0620X | Adult Care Home Facility | — | NULL | Yes |
| 313M00000X | Nursing Facility/Intermediate Care Facility | — | NULL | — |
| 314000000X | Skilled Nursing Facility | — | NULL | — |
| 315P00000X | Intellectual Disabilities Intermediate Care Facility | — | NULL | — |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | — |
| 324500000X | Substance Abuse Rehabilitation Facility | — | NULL | — |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 332BN1400X | Nursing Facility Supplies (DME) | — | NULL | — |
| 332BX2000X | Oxygen Equipment & Supplies (DME) | — | NULL | — |
| 332U00000X | Home Delivered Meals | — | NULL | — |
| 343800000X | Secured Medical Transport (VAN) | — | NULL | — |
| 347C00000X | Private Vehicle | — | NULL | — |
| 385H00000X | Respite Care | — | NULL | — |
| 385HR2060X | Child Intellectual and/or Developmental Disabilities Respite Care | — | NULL | — |

## Other

- **Enumeration date:** 09/14/2016
- **Last updated:** 09/14/2016