Provider Demographics
NPI:1780816009
Name:GLOVER, ELLA MARIA
Entity Type:Individual
Prefix:
First Name:ELLA
Middle Name:MARIA
Last Name:GLOVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EXCELLENT
Other - Middle Name:HOME
Other - Last Name:CARE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8517 KIRKLEY GLEN LN STE 113
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-8049
Mailing Address - Country:US
Mailing Address - Phone:704-200-1413
Mailing Address - Fax:980-242-3496
Practice Address - Street 1:1135 FOUR LAKES DR STE H
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-1743
Practice Address - Country:US
Practice Address - Phone:704-249-2553
Practice Address - Fax:980-242-3496
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4581253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care