Provider Demographics
NPI:1205513504
Name:VICTORY PLACE HOMECARE SERVICES, LLC
Entity type:Organization
Organization Name:VICTORY PLACE HOMECARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE-CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BANKOLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:267-767-3836
Mailing Address - Street 1:501 CENTENNIAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:GILBERTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19525
Mailing Address - Country:US
Mailing Address - Phone:267-767-3836
Mailing Address - Fax:484-949-8766
Practice Address - Street 1:501 CENTENNIAL AVENUE
Practice Address - Street 2:
Practice Address - City:GILBERTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19525
Practice Address - Country:US
Practice Address - Phone:267-767-3836
Practice Address - Fax:484-949-8766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care