Provider Demographics
NPI:1053836536
Name:GLORIAS ANGELS LLC
Entity Type:Organization
Organization Name:GLORIAS ANGELS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:RAFFERTY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:904-318-5275
Mailing Address - Street 1:5615 VILLAGE POND CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32222-1159
Mailing Address - Country:US
Mailing Address - Phone:904-318-5275
Mailing Address - Fax:
Practice Address - Street 1:5615 VILLAGE POND CIR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32222-1159
Practice Address - Country:US
Practice Address - Phone:904-318-5275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty