Provider Demographics
NPI:1366679805
Name:GLORY PSYCHIATRIC CENTER, INC.
Entity Type:Organization
Organization Name:GLORY PSYCHIATRIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:BANAG
Authorized Official - Last Name:MONTES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-894-6980
Mailing Address - Street 1:2316 HILLCREST ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4900
Mailing Address - Country:US
Mailing Address - Phone:407-894-6980
Mailing Address - Fax:407-894-6982
Practice Address - Street 1:2316 HILLCREST ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4900
Practice Address - Country:US
Practice Address - Phone:407-894-6980
Practice Address - Fax:407-894-6982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP04000046349251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6508Medicare UPIN