Provider Demographics
NPI:1245400910
Name:GLORY ASSISTED ;LIVING FACILITY
Entity Type:Organization
Organization Name:GLORY ASSISTED ;LIVING FACILITY
Other - Org Name:NONE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/ ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:DELPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MELBOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-432-3404
Mailing Address - Street 1:7221 UDINE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8446
Mailing Address - Country:US
Mailing Address - Phone:407-432-3404
Mailing Address - Fax:
Practice Address - Street 1:7221 UDINE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8446
Practice Address - Country:US
Practice Address - Phone:407-432-3404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-09
Last Update Date:2008-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility