Provider Demographics
NPI:1558515759
Name:GLORY DIVINE HOME CARE INC
Entity Type:Organization
Organization Name:GLORY DIVINE HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEDDRA
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:225-473-8911
Mailing Address - Street 1:3443 HIGHWAY 1 S
Mailing Address - Street 2:
Mailing Address - City:DONALDSONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70346-9707
Mailing Address - Country:US
Mailing Address - Phone:225-473-8911
Mailing Address - Fax:225-473-8914
Practice Address - Street 1:3443 HIGHWAY 1 S
Practice Address - Street 2:
Practice Address - City:DONALDSONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70346-9707
Practice Address - Country:US
Practice Address - Phone:225-473-8911
Practice Address - Fax:225-473-8914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services