Victory Homes

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

201700008C Issued in IL

Legal business name

VICTORY HOMES

Practice address

20105 Redwood Ave
Lynwood, IL 60411-6804

Phone

(773) 507-6379

Fax

(708) 251-5646

NPI assigned

Oct 6, 2017

Organization subpart

No

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

Authorized official

Name

Abimbola Ogunlola, RN,BSN

Title

Ceo

Phone

(773) 507-6379

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1507248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507248000000",
    "number": "1447760210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20139 DRIFTWOOD AVE",
            "city": "LYNWOOD",
            "state": "IL",
            "postal_code": "604116812",
            "telephone_number": "773-507-6379",
            "fax_number": "708-251-5646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20105 REDWOOD AVE",
            "city": "LYNWOOD",
            "state": "IL",
            "postal_code": "604116804",
            "telephone_number": "773-507-6379",
            "fax_number": "708-251-5646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY HOMES",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-06",
        "last_updated": "2017-10-06",
        "status": "A",
        "authorized_official_last_name": "OGUNLOLA",
        "authorized_official_first_name": "ABIMBOLA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "773-507-6379",
        "authorized_official_credential": "RN,BSN"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "IL",
            "license": "201700008C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Darius Strong, LPC
• Melisa Taylor
• Nicole Z Thompson, OTR
• Thrive Integrative Inc.
• Olamide Tunde Ali, LCPC
• Village of Lynwood
• Ashir Wahab, MD
• Chartiece Walker
• Walking in His Purpose
• Donald Washington

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Lynwood, IL
• Providers in Lynwood, IL by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2017; 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.