Provider Demographics
NPI:1346543741
Name:GLORY HOSPICE & PALLIATIVE CARE COMPANY
Entity Type:Organization
Organization Name:GLORY HOSPICE & PALLIATIVE CARE COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:GARDENHIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-507-5445
Mailing Address - Street 1:122 ENTERPRISE CT
Mailing Address - Street 2:SUITE D
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-3651
Mailing Address - Country:US
Mailing Address - Phone:706-507-5445
Mailing Address - Fax:706-507-5488
Practice Address - Street 1:122 ENTERPRISE CT
Practice Address - Street 2:SUITE D
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-3651
Practice Address - Country:US
Practice Address - Phone:706-507-5445
Practice Address - Fax:706-507-5488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111715OtherMEDICARE PROVIDER NUMBER