Organization
VICTORY PROVIDER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAMARIA JENKINS (CEO)
(352) 215-7964
Entity
Organization
Contact information
Practice address
6921 NW 22ND ST STE 1, GAINESVILLE, FL 32653-1228
(352) 215-7964
Mailing address
6921 NW 22ND ST STE 1, GAINESVILLE, FL 32653-1228
(352) 215-7964
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
251E00000X
Home Health Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
Other
Enumeration date
08/27/2025
Last updated
08/27/2025
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