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VICTORY CARE HOSPICE
NPI 1962012401
Hospice Care, Community Based in San Bernardino, CA

Active since August 07, 2020CLIA 05D2197089 · Waiver
1254 S WATERMAN AVE STE 54, SAN BERNARDINO, CA 92408(909) 521-7988(909) 363-7433 Get Directions Write a Review

NPPES record last updated: August 7, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Victory Care Hospice NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

VICTORY CARE HOSPICE (NPI 1962012401) is a healthcare organization registered as a hospice care, community based in San Bernardino, California and active in the NPI registry since August 2020. The organization holds a CLIA Waiver certificate valid through October 20, 2026 and lists Lateisha Mcdonald, Ceo, as its authorized official.

NPPES Registry Identity

NPI1962012401
Entity TypeOrganization
Primary Taxonomy251G00000X
Legal Business NameVICTORY CARE HOSPICE
Location Address1254 S WATERMAN AVE STE 54San Bernardino, CA 92408-2859
Mailing Address1254 S Waterman Ave Ste 54San Bernardino, CA 92408-2859
Phone(909) 521-7988
Fax(909) 363-7433
Organization SubpartNo
Authorized OfficialLateisha McdonaldCeo · (909) 521-7988
Enumeration DateAugust 7, 2020
NPPES CertifiedAugust 7, 2020
✔ NPI 1962012401 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyHospice Care, Community BasedAgencies
Taxonomy Code251G00000X
1254 S WATERMAN AVE STE 54, San Bernardino, CA 92408
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2197089

Victory Care Hospice · San Bernardino, CA
Active · expires Oct 20, 2026
CLIA Number05D2197089
Laboratory TypeHome Health Agency
Certificate Effective DateOctober 21, 2024
Certificate Expiration DateOctober 20, 2026
Laboratory DirectorJo Ann C. Pullen
Laboratory Phone(909) 521-7988
Laboratory LocationVictory Care Hospice1254 S Waterman Ave Ste 54, San Bernardino, CA 92408
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Victory Care Hospice's NPI number?

The NPI number for Victory Care Hospice is 1962012401. It was assigned to this organization in the NPPES registry on August 7, 2020.

Where is Victory Care Hospice located?

Victory Care Hospice is located at 1254 S Waterman Ave Ste 54, San Bernardino, CA 92408. The listed phone number is (909) 521-7988.

What is Victory Care Hospice's specialty?

The primary specialty registered for this NPI is Hospice Care, Community Based with taxonomy code 251G00000X.

Does Victory Care Hospice hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2197089) is associated with this NPI, valid through October 20, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Victory Care Hospice was last updated on August 7, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.