Provider Demographics
NPI:1376153049
Name:GLORY PROFESSIONAL HOME SERVICES INC
Entity Type:Organization
Organization Name:GLORY PROFESSIONAL HOME SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO - RN
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:OBIEKWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-906-7421
Mailing Address - Street 1:6781 LONDONDERRY WAY STE 5
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-2094
Mailing Address - Country:US
Mailing Address - Phone:770-906-7421
Mailing Address - Fax:770-626-3164
Practice Address - Street 1:6781 LONDONDERRY WAY STE 5
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-2094
Practice Address - Country:US
Practice Address - Phone:770-906-7421
Practice Address - Fax:770-626-3164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPHCP010418Medicaid