Provider Demographics
NPI:1073532149
Name:GLORY HEALTH CENTER INC
Entity Type:Organization
Organization Name:GLORY HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMSON
Authorized Official - Middle Name:TOKUN
Authorized Official - Last Name:AJAHI
Authorized Official - Suffix:
Authorized Official - Credentials:BSC, MS, MED, PHD
Authorized Official - Phone:410-444-0779
Mailing Address - Street 1:4705B HARFORD ROAD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214
Mailing Address - Country:US
Mailing Address - Phone:410-444-0779
Mailing Address - Fax:410-444-0669
Practice Address - Street 1:4705B HARFORD ROAD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214
Practice Address - Country:US
Practice Address - Phone:410-444-0779
Practice Address - Fax:410-444-0669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)