Provider Demographics
NPI:1790071744
Name:MORNING GLORY HOME HEALTH LLC
Entity Type:Organization
Organization Name:MORNING GLORY HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:HUNG
Authorized Official - Middle Name:MINH
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-367-3723
Mailing Address - Street 1:1600 NW 2ND AVE
Mailing Address - Street 2:19
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-1626
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 NW 2ND AVE
Practice Address - Street 2:19
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-1626
Practice Address - Country:US
Practice Address - Phone:561-367-3732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health