Provider Demographics
NPI:1346811379
Name:GLORY HOMES, INC
Entity Type:Organization
Organization Name:GLORY HOMES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEWUMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-407-9954
Mailing Address - Street 1:15168 WISTERIA LN
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394-9543
Mailing Address - Country:US
Mailing Address - Phone:310-407-9954
Mailing Address - Fax:
Practice Address - Street 1:15045 BRUCITE RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92394-0541
Practice Address - Country:US
Practice Address - Phone:760-867-3267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility