Victory Home Health, LLC
Organization Active NPI Home Health Agency · Elgin, OK
NPI 1497733182 · NPPES record last updated Aug 18, 2016
Key facts
- NPI
- 1497733182
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- License
- 7767 (OK)
- Legal business name
- VICTORY HOME HEALTH, LLC
- Practice address
- 104 Thoma Dr Ste 1
Box 769
Elgin, OK 73538-2203 - Phone
- (580) 492-6166
- Fax
- (580) 492-6160
- NPI assigned
- Jan 4, 2006
- Organization subpart
- No
Authorized official
- Name
- Kim Cripps, RN
- Title
- Administrator
- Phone
- (580) 371-2002
Change of ownership 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| Jul 21, 2023 | Change of Ownership |
A Path of Care Home Health VI, LLC |
National Provider Directory
Locations
2520 Arlington St
Ada, OK 74820
304 E Main St
Davis, OK 73030
Phone (405) 369-5510
2814 N 1st Ave
Durant, OK 74701
Phone (580) 931-3707
750 E Main St
Tishomingo, OK 73460
Phone (580) 371-2002
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 7767 | OK | Yes |
Addresses
Primary practice location
104 Thoma Dr Ste 1
Box 769
Elgin, OK 73538-2203
Mailing address
714 E Main St
Tishomingo, OK 73460-2350
Phone (580) 371-2002
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100262440B | Medicaid | OK | |
| 100262440L | Medicaid | OK | |
| 100262440C | Medicaid | OK | |
| 100262440K | Medicaid | OK |
Other names
- Victory Home Health and Hospice
Other providers in Elgin, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 18, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.