Provider Demographics
NPI:1144538638
Name:VICTORY HOME HEALTH OF TX, LLC
Entity type:Organization
Organization Name:VICTORY HOME HEALTH OF TX, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HR/SUPPORT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ASHLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-458-9012
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75091-0325
Mailing Address - Country:US
Mailing Address - Phone:903-458-9012
Mailing Address - Fax:855-710-7022
Practice Address - Street 1:600 E TAYLOR ST STE 300
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2841
Practice Address - Country:US
Practice Address - Phone:855-942-3687
Practice Address - Fax:855-710-7022
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VICTORY HOME HEALTH OF TX, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-17
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
TX011510251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX191844301Medicaid
TX191844301Medicaid