Provider Demographics
NPI:1033930110
Name:VICTORY HEALTH & WELLNESS LLC
Entity type:Organization
Organization Name:VICTORY HEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:MURIMI
Authorized Official - Last Name:KAMAU
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:781-334-8878
Mailing Address - Street 1:2 ELECTRONICS AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1071
Mailing Address - Country:US
Mailing Address - Phone:781-334-8878
Mailing Address - Fax:
Practice Address - Street 1:2 ELECTRONICS AVE STE 10
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1071
Practice Address - Country:US
Practice Address - Phone:781-334-8878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)