Victory Health Home PLLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

VICTORY HEALTH HOME PLLC

Practice address

3887 E Citrine Rd
San Tan Valley, AZ 85143-5688

Phone

(602) 502-4872

Fax

(480) 210-3563

NPI assigned

Sep 11, 2023

Last updated

Jan 15, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Ibukun Odutola, PMHNP

Title

DNP Ceo

Phone

(480) 202-4597

Specialties & licenses 2

Addresses

Tax ID family

Victory Health Home PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Victory Health Home PLLC

  • Mental Illness Community Based Residential Treatment Facility
  • Phoenix, AZ
  • NPI 1609633080
  NPD tax ID

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

{
    "created_epoch": "1694390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768435200000",
    "number": "1487431805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3887 E CITRINE RD",
            "city": "SAN TAN VALLEY",
            "state": "AZ",
            "postal_code": "851435688",
            "telephone_number": "480-202-4597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3887 E CITRINE RD",
            "city": "SAN TAN VALLEY",
            "state": "AZ",
            "postal_code": "851435688",
            "telephone_number": "602-502-4872",
            "fax_number": "480-210-3563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY HEALTH HOME PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-11",
        "last_updated": "2026-01-15",
        "certification_date": "2026-01-15",
        "status": "A",
        "authorized_official_last_name": "ODUTOLA",
        "authorized_official_first_name": "IBUKUN",
        "authorized_official_title_or_position": "DNP CEO",
        "authorized_official_telephone_number": "480-202-4597",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PMHNP"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erica Renae Van Beuge, PA-C
• Ryan Vance, PT
• Dalene Vasconcelles, LPN
• Oladiji Gbolahan Vaughan, MD
• James Verdieu
• Victory Residential Corporation
• Hunter Vincent, PT
• Katelyn Anne Virnelson, PA-C
• Ashley Vliet, RBT
• Iryna Von Esch, LCSW

• Mental Illness Community Based Residential Treatment Facility in San Tan Valley, AZ
• Providers in San Tan Valley, AZ by specialty
• Mental Illness Community Based Residential Treatment Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2026; 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.