VICTORIOUS HEALTHCARE L.L.C. (NPI# 1912455361) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912455361 |
| Entity Type | Organization |
| Organization Name | VICTORIOUS HEALTHCARE L.L.C. |
| Practice Address |
4959 Laurel Oak Dr Jackson MS 39212-2150 |
| Practice Telephone | 6012094278 |
| Mailing Telephone | 6012094278 |
| Enumeration Date | 2016-09-14 |
| Last Update Date | 2016-09-14 |
| Authorized Official Name | MS. MARY JEAN BEN (C.E. O.) |
| Authorized Official Telephone | 6012094278 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 310400000X | Assisted Living Facility | Nursing & Custodial Care Facilities | ||
| N | 313M00000X | Nursing Facility/Intermediate Care Facility | Nursing & Custodial Care Facilities | ||
| N | 314000000X | Skilled Nursing Facility | Nursing & Custodial Care Facilities | ||
| N | 315P00000X | Intermediate Care Facility, Mentally Retarded | Nursing & Custodial Care Facilities | ||
| N | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities | ||
| N | 324500000X | Substance Abuse Rehabilitation Facility | Residential Treatment Facilities | ||
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| N | 332BN1400X |
Durable Medical Equipment & Medical Supplies Specialization: Nursing Facility Supplies |
Suppliers | ||
| N | 332BX2000X |
Durable Medical Equipment & Medical Supplies Specialization: Oxygen Equipment & Supplies |
Suppliers | ||
| N | 332U00000X | Home Delivered Meals | Suppliers | ||
| N | 343800000X | Secured Medical Transport (VAN) | Transportation Services | ||
| N | 347C00000X | Private Vehicle | Transportation Services | ||
| N | 385H00000X | Respite Care | Respite Care Facility | ||
| N | 385HR2060X |
Respite Care Specialization: Respite Care, Mental Retardation and/or Developmental Disabilities, Child |
Respite Care Facility | ||
| Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
Nursing & Custodial Care Facilities |
| Street Address |
4959 LAUREL OAK DR |
| City | JACKSON |
| State | MS |
| Zip Code | 39212-2150 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013406172 | South Central Community Action Agency, Inc | Non-emergency Medical Transport (VAN) | 3891 I-55 South Frontage Rd, Jackson, MS 39212 | 2018-05-04 |
| 1508305780 | Caring Companions LLC | Home Health | 1024 Cooper Rd, Jackson, MS 39212 | 2017-02-21 |
| 1750634044 | Christians In Action, Inc. | Community/Behavioral Health | 2025 North Siwell Rd, Jackson, MS 39212 | 2012-10-24 |
| 1609164748 | Counseling and Mentoring Program | Community/Behavioral Health | 2964 Terry Road B-1, Jackson, MS 39212 | 2011-07-11 |
| 1407179039 | Caring Hands Community Services Inc | Skilled Nursing Facility | 3318 Longwood Drive, Jackson, MS 39212 | 2010-03-10 |
| 1992239404 | Shaemik Harris | Registered Nurse | 3520 Sykes Park Dr, Jackson, MS 39212 | 2017-04-12 |
| 1780044438 | Alfonzo Haralson | Counselor | 132 Thousand Oaks Cir, Jackson, MS 39212-2046 | 2016-02-24 |
| 1659384063 | Kentrell Marie Liddell | Family Medicine | 2104 Thousand Oaks Dr, Jackson, MS 39212-2048 | 2006-08-15 |
| 1649819590 | George Cavett Jr. | Nurse Practitioner | 2450 Twisted Oak Dr, Jackson, MS 39212-2137 | 2019-12-24 |
| 1235523549 | Chanda M Rhodes | Counselor | 125 Cedarwood Dr, Jackson, MS 39212-2208 | 2015-03-25 |
| Find all providers in zip 39212 | ||||
| Taxonomy Code | 311ZA0620X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Custodial Care Facility |
| Specialization | Adult Care Home |
| A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336754696 | David L Thompson | Custodial Care Facility | 59 West St, Jackson, OH 45640-1566 | 2020-09-14 |
| 1265045223 | Charity Baker | Custodial Care Facility | 677 Westwood Ave, Jackson, TN 38301-4230 | 2020-08-28 |
| 1164845210 | R S Enterprise | Custodial Care Facility | 532 Burns St, Jackson, MS 39203-3601 | 2014-01-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912540428 | Jennifer Lashon May | Custodial Care Facility | 141 Jefferson Street Ste, C, Monticello, MS 39654-3965 | 2019-10-28 |
| 1255866059 | Personal Touch LLC | Custodial Care Facility | 614 Chippewah Dr, Laurel, MS 39443-7413 | 2017-04-29 |
| 1164964003 | Creative Image Personal Care Service LLC | Custodial Care Facility | 503 Highway 82 E, Indianola, MS 38751-2317 | 2016-11-09 |
| 1679943310 | Educare Senior Day Center (vicksburg Branch) | Custodial Care Facility | 3202 Wisconsin Ave, Vicksburg, MS 39180-5351 | 2015-10-06 |
| 1659747988 | Aging Gracefully Community Center | Custodial Care Facility | 16165 Highway 51, Hazlehurst, MS 39083-2002 | 2015-08-20 |
| 1215315528 | Serenityhomecare | Custodial Care Facility | 1512 Clinton Raymond Rd, Clinton, MS 39056-5400 | 2015-05-07 |
| 1356765101 | Healthyland Adult Day Care, LLC | Custodial Care Facility | 227 Pecan Street, Marks, MS 38646 | 2014-02-14 |
| 1053746487 | Assurance Home Care Agency LLC | Custodial Care Facility | 1549 Shiloh Church Rd, Newton, MS 39345-9024 | 2013-09-04 |
| 1790119519 | Pressicare, Inc | Custodial Care Facility | 20434 Old Houston Rd, Aberdeen, MS 39730-8548 | 2013-08-28 |
| 1295084325 | The Way of Life Adult Day Care Inc | Custodial Care Facility | 1356 Newport Rd, Lexington, MS 39095-5869 | 2012-09-05 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.