NPIMap

Organization Active NPI

Victory Health Care Services LLC

Doing business as Victory Health Care Services

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Baltimore, MD
National Provider Identifier
1063910859
Registry record updated Dec 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X
Legal business name
VICTORY HEALTH CARE SERVICES LLC
Doing business as
Victory Health Care Services LLC
Victory Health Care Services
Practice address
499C Beaumont Avenue
Suite 18
Baltimore, MD 21212
Phone
(443) 204-5144
Fax
(667) 212-2430
NPI assigned
Jan 26, 2018
Last updated
Dec 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Bode Akadri, BED, MMP
Title
Program Director
Phone
(443) 204-5144

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X Primary
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

499C Beaumont Avenue
Suite 18
Baltimore, MD 21212

Mailing address

1900 E Northern Pkwy Ste 205207
Baltimore, MD 21239-2113
Phone (443) 204-5144

Other identifiers 2

IdentifierTypeStateIssuer
666466100MedicaidMD
1972978716MedicaidMD

Other names 2

  • VICTORY HEALTH CARE SERVICES LLC Doing business as
  • Victory Health Care Services Doing business as

National Provider Directory

National Provider Directory

Locations

5808 York Rd
Fl 2
Baltimore, MD 21212
Phone (443) 204-5144

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1516924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733788800000",
    "number": "1063910859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 E NORTHERN PKWY STE 205207",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212392113",
            "telephone_number": "443-204-5144",
            "fax_number": "410-617-8478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "499C BEAUMONT AVENUE",
            "address_2": "SUITE 18",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21212",
            "telephone_number": "443-204-5144",
            "fax_number": "667-212-2430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY HEALTH CARE SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-26",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-10",
        "status": "A",
        "authorized_official_last_name": "AKADRI",
        "authorized_official_first_name": "BODE",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "443-204-5144",
        "authorized_official_credential": "BED, MMP"
    },
    "taxonomies": [
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "666466100",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1972978716",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VICTORY HEALTH CARE SERVICES LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Victory Health Care Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.