Provider Demographics
NPI:1407502503
Name:GLORIA HOMES
Entity Type:Organization
Organization Name:GLORIA HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:STARKS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:502-302-0219
Mailing Address - Street 1:1512 PORTLAND AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203
Mailing Address - Country:US
Mailing Address - Phone:502-302-0219
Mailing Address - Fax:
Practice Address - Street 1:1512 PORTLAND AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203
Practice Address - Country:US
Practice Address - Phone:502-302-0219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-27
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health