NPIMap

Organization Active NPI

Villaraza Corporation

Doing business as DBA: Victory Home Care Agency

  • Home Health Agency
  • Mesa, AZ
National Provider Identifier
1972505881
Registry record updated Apr 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
HHA 3549 Issued in AZ
Legal business name
VILLARAZA CORPORATION
Doing business as
DBA: Victory Home Care Agency
Practice address
1212 N Spencer
Suite 1
Mesa, AZ 85203-4347
Phone
(480) 726-6553
Fax
(480) 726-3329
NPI assigned
Aug 10, 2005
Last updated
Apr 2, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2012

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

Authorized official

Name
Mrs. Eva Lorane Tejada Ward, RN
Title
Administrator
Phone
(480) 726-6553

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X HHA 3549 AZ Primary

Addresses

Primary practice location

1212 N Spencer
Suite 1
Mesa, AZ 85203-4347

Mailing address

P.O. Box 790
Mesa, AZ 85211-0790
Phone (480) 726-6553

Other identifiers 1

IdentifierTypeStateIssuer
HHA 3549OtherAZSTATE LICENSE NUMBER

Other names 1

  • DBA: Victory Home Care Agency Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040428001541 AZ Part A Provider - Home Health Agency 7719974963 Practice locations: Mesa, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972505881. Details of each certification follow.

Home health agency certification: CCN 037230

Legal name
VILLARAZA CORPORATION
Doing business as
VICTORY HOME CARE AGENCY
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Aug 27, 2004
Last certification
Mar 28, 2019
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Jan 13, 2004 in AZ
Enrollment address
1212N Spencer 1
Mesa, AZ 85203-4347
HHA Branch

Care Compare: Home health agency

Medicare Care Compare
Listed as
Victory Home Care AgencyCCN 037230 · All quality measures
Overall star rating
5 of 5
Ownership
Proprietary
Certified
Aug 27, 2004
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D1025468Victory Home Care Agency1212 N Spencer St, Ste 1, Mesa, AZ 85203Certificate of waiverMay 6, 2028

National Provider Directory

National Provider Directory

Locations

401 N Alma School Rd
Ste 12A
Chandler, AZ 85224
Phone (480) 726-6553

1103 S Mesa Dr
#1
Mesa, AZ 85210
Phone (480) 726-6553

1212 N Spencer
#1
Mesa, AZ 85203
Phone (480) 726-6553

1212 N Spencer
Ste 1
Mesa, AZ 85203
Phone (480) 726-6553

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Eva Lorane Ward Individual 5% Or Greater Direct Ownership Interest Jan 6, 2004 50%
Corporate OfficerCeo Jan 13, 2004 100%
W-2 Managing EmployeeCeo Jan 6, 2004 100%
Benjamin V Tejada Individual 5% Or Greater Direct Ownership Interest Jan 6, 2004 50%

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

  • Eva Lorane Ward
    • Student in an Organized Health Care Education/Training Program
    • Mesa, AZ
    • NPI 1437981214
    NPD

Affiliated clinicians 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1123632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333324800000",
    "number": "1972505881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 790",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852110790",
            "telephone_number": "480-726-6553",
            "fax_number": "480-726-3329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1212 N SPENCER",
            "address_2": "SUITE 1",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852034347",
            "telephone_number": "480-726-6553",
            "fax_number": "480-726-3329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLARAZA CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-10",
        "last_updated": "2012-04-02",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "EVA LORANE",
        "authorized_official_middle_name": "TEJADA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "480-726-6553",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "AZ",
            "license": "HHA 3549",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "HHA 3549",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DBA: Victory Home Care Agency",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.