Provider Demographics
NPI:1043091853
Name:VICTORYBRIDGE HEALTHCARE, LLC
Entity type:Organization
Organization Name:VICTORYBRIDGE HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:AGBONMA
Authorized Official - Last Name:ODOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:202-413-2078
Mailing Address - Street 1:1914 ROSEBAY CT
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4037
Mailing Address - Country:US
Mailing Address - Phone:202-413-2078
Mailing Address - Fax:
Practice Address - Street 1:1720 E 32ND ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-8304
Practice Address - Country:US
Practice Address - Phone:202-413-2078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-09
Last Update Date:2025-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)