Provider Demographics
NPI:1881904282
Name:VICTORIA PERSONAL CARE HOME #I
Entity type:Organization
Organization Name:VICTORIA PERSONAL CARE HOME #I
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-781-4134
Mailing Address - Street 1:2666 NANCY DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31206-4941
Mailing Address - Country:US
Mailing Address - Phone:478-978-4122
Mailing Address - Fax:478-781-4134
Practice Address - Street 1:2666 NANCY DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31206-4941
Practice Address - Country:US
Practice Address - Phone:478-978-4122
Practice Address - Fax:478-781-4134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health