Victory Home Health Agency

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

VICTORY HOME HEALTH AGENCY

Practice address

24490 Sunnymead Blvd Ste 108
Moreno Valley, CA 92553-7762

Phone

(951) 924-5114

Fax

(951) 924-5182

NPI assigned

Jan 3, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Jecinta Nkeiruka Azonobi, LVN

Title

Assistant Administrator

Phone

(951) 924-5114

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Home health agency certification: CCN 058190

Legal name

VICTORY HOME HEALTH AGENCY

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Aug 20, 2003

Last certification

Jan 11, 2018

Ownership / control type

Non-Profit

Organization structure

PartnershipProprietary

Enrollment address

24490 Sunnymead Blvd
Ste 108
Moreno Valley, CA 92553-7762

Listed as

Victory Home Health AgencyCCN 058190

Ownership

Non-Profit

Certified

Aug 20, 2003

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Locations

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• David Fukuda, M.D.

  • Family Medicine Physician
  • Redlands, CA
  • NPI 1750467874

  Corporate Director

  CMS ownership
• Bernice Chinyere Ivoko

  • Family Nurse Practitioner
  • Rancho Cucamonga, CA
  • NPI 1063059806

  Corporate Director, Corporate Officer, General Partnership Interest

  CMS ownership

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164589321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24490 SUNNYMEAD BLVD STE 108",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925537762",
            "telephone_number": "951-924-5114",
            "fax_number": "951-924-5182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24490 SUNNYMEAD BLVD STE 108",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925537762",
            "telephone_number": "951-924-5114",
            "fax_number": "951-924-5182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY HOME HEALTH AGENCY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "AZONOBI",
        "authorized_official_first_name": "JECINTA",
        "authorized_official_middle_name": "NKEIRUKA",
        "authorized_official_title_or_position": "ASSISTANT ADMINISTRATOR",
        "authorized_official_telephone_number": "951-924-5114",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LVN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HHA08190F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Javier Venegas Jr., BS
• Lisbeth Nanet Venegas, L.M.F.T./CT II
• Angela Vera
• Savannah Vest, AMFT, APCC
• Vet Phoenix
• Kristine Vidal
• Araceli B Vides
• Lisa Marie Vigil, RADT
• Cindy Vilda
• David Gabriel Villa

• Home Health Agency in Moreno Valley, CA
• Providers in Moreno Valley, CA by specialty
• Home Health Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.