Provider Demographics
NPI:1609273150
Name:GLORIOUS LIFE FIRST CHOICE LLC
Entity Type:Organization
Organization Name:GLORIOUS LIFE FIRST CHOICE LLC
Other - Org Name:GLORIOUS LIFE HOME CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-225-9009
Mailing Address - Street 1:405 GLENVIEW LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-9482
Mailing Address - Country:US
Mailing Address - Phone:919-225-9009
Mailing Address - Fax:866-920-8136
Practice Address - Street 1:3622 SHANNON RD
Practice Address - Street 2:SUITE 104
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3771
Practice Address - Country:US
Practice Address - Phone:919-908-1511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-28
Last Update Date:2014-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4606251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health