Provider Demographics
NPI:1114228665
Name:GLORIA HOME CARE AGENCY AND SUPPORT STAFFING INC
Entity Type:Organization
Organization Name:GLORIA HOME CARE AGENCY AND SUPPORT STAFFING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-249-7717
Mailing Address - Street 1:428 CONNELL RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1481
Mailing Address - Country:US
Mailing Address - Phone:229-249-7717
Mailing Address - Fax:229-231-3030
Practice Address - Street 1:428 CONNELL RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1481
Practice Address - Country:US
Practice Address - Phone:229-249-7717
Practice Address - Fax:229-231-3030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-14
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA092-R-0566251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care