Provider Demographics
NPI:1730831694
Name:VICTORIA CARE MANAGEMENT
Entity type:Organization
Organization Name:VICTORIA CARE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAMUNOTONYE
Authorized Official - Middle Name:
Authorized Official - Last Name:FIABEMA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:919-904-8524
Mailing Address - Street 1:5700 RYDER AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-8304
Mailing Address - Country:US
Mailing Address - Phone:191-990-4842
Mailing Address - Fax:
Practice Address - Street 1:11936 N COMMUNITY HOUSE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4978
Practice Address - Country:US
Practice Address - Phone:919-904-8524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty