Provider Demographics
NPI:1376155804
Name:GLORY FOR LIFE HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:GLORY FOR LIFE HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MBANGOWAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-992-0087
Mailing Address - Street 1:5969 E LIVINGSTON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-2907
Mailing Address - Country:US
Mailing Address - Phone:717-992-0087
Mailing Address - Fax:
Practice Address - Street 1:5969 E LIVINGSTON AVE STE 201
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-2907
Practice Address - Country:US
Practice Address - Phone:717-992-0087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-17
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty