Victory Care Hospice

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

VICTORY CARE HOSPICE

Practice address

1254 S Waterman Ave Ste 54
San Bernardino, CA 92408-2859

Phone

(909) 521-7988

Fax

(909) 363-7433

NPI assigned

Aug 7, 2020

Organization subpart

No

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

Authorized official

Name

Lateisha McDonald

Title

Ceo

Phone

(909) 521-7988

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Hospice certification: CCN D61507

Legal name

VICTORY CARE HOSPICE

Certification status

Active

Provider type (POS)

Hospice

Participating since

Apr 30, 2024

Last certification

Apr 23, 2024

Organization structure

CorporationProprietary

Incorporated

Jul 2, 2020 in CA

Enrollment address

1254 S Waterman Ave
Ste 54
San Bernardino, CA 92408-2859

Listed as

Victory Care HospiceCCN D61507

Certified

Apr 30, 2024

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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 1

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

• Jo Ann Pullen, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Los Angeles, CA
  • NPI 1225005663

  Contracted Managing Employee

  CMS ownership

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Jo Ann Pullen, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Los Angeles, CA
  • NPI 1225005663

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1596758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596758400000",
    "number": "1962012401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1254 S WATERMAN AVE STE 54",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924082859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1254 S WATERMAN AVE STE 54",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924082859",
            "telephone_number": "909-521-7988",
            "fax_number": "909-363-7433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY CARE HOSPICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-07",
        "last_updated": "2020-08-07",
        "certification_date": "2020-08-07",
        "status": "A",
        "authorized_official_last_name": "MCDONALD",
        "authorized_official_first_name": "LATEISHA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "909-521-7988"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "EMAILADDRESS",
            "affiliation": "N",
            "endpointDescription": "EMAIL",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "EMAIL",
            "address_1": "1254 S Waterman Ave Ste 54",
            "city": "San Bernardino",
            "state": "CA",
            "country_code": "US",
            "postal_code": "924082859",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Victor Treatment Centers, Inc.
• Victory Care Inc
• John Edward Victory
• Dolores Vicuna
• Ana Ashley Vidaurrazaga
• Melissa Agustina Viera Aragon

• All providers in San Bernardino, CA
• Community Based Hospice Care Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 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.