Provider Demographics
NPI:1710324520
Name:SHEKINAH GLORY HOME CARE, INC.
Entity Type:Organization
Organization Name:SHEKINAH GLORY HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NADINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-926-2897
Mailing Address - Street 1:2565 PARMA ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-5127
Mailing Address - Country:US
Mailing Address - Phone:941-926-2897
Mailing Address - Fax:941-924-0987
Practice Address - Street 1:2565 PARMA ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-5127
Practice Address - Country:US
Practice Address - Phone:941-926-2897
Practice Address - Fax:941-924-0987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL141614600Medicaid