Provider Demographics
NPI:1225740806
Name:GLORY HEARING CARE, PLLC
Entity Type:Organization
Organization Name:GLORY HEARING CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:MARIELLE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:313-333-0534
Mailing Address - Street 1:43001 W 9 MILE RD.
Mailing Address - Street 2:SUITE 109 PMB 2041
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375
Mailing Address - Country:US
Mailing Address - Phone:313-333-0534
Mailing Address - Fax:
Practice Address - Street 1:43001 W 9 MILE RD.
Practice Address - Street 2:SUITE 109 PMB 2041
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375
Practice Address - Country:US
Practice Address - Phone:313-333-0534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI15013663Medicaid