Provider Demographics
NPI:1164154340
Name:LA GLORIA HOME PROVIDER SERVICES LLC
Entity Type:Organization
Organization Name:LA GLORIA HOME PROVIDER SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAILEE
Authorized Official - Middle Name:DESTINY
Authorized Official - Last Name:GALLEGOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-373-2108
Mailing Address - Street 1:327 FOREST HILLS DR
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-7719
Mailing Address - Country:US
Mailing Address - Phone:956-373-2108
Mailing Address - Fax:956-300-7222
Practice Address - Street 1:327 FOREST HILLS DR
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-7719
Practice Address - Country:US
Practice Address - Phone:956-373-2108
Practice Address - Fax:956-300-7222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-27
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty