Provider Demographics
NPI:1295198430
Name:GLORIOUS HOME HEALTH
Entity Type:Organization
Organization Name:GLORIOUS HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-258-5600
Mailing Address - Street 1:124B S MAIN ST
Mailing Address - Street 2:POBOX 1306
Mailing Address - City:BROADWAY
Mailing Address - State:NC
Mailing Address - Zip Code:27505-9701
Mailing Address - Country:US
Mailing Address - Phone:919-258-5600
Mailing Address - Fax:
Practice Address - Street 1:124B S MAIN ST
Practice Address - Street 2:
Practice Address - City:BROADWAY
Practice Address - State:NC
Practice Address - Zip Code:27505-9701
Practice Address - Country:US
Practice Address - Phone:919-258-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care