Provider Demographics
NPI:1790476935
Name:GLAM HEALTHCARE INC
Entity Type:Organization
Organization Name:GLAM HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIRISU
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:773-739-3668
Mailing Address - Street 1:3601 W DEVON AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-1216
Mailing Address - Country:US
Mailing Address - Phone:312-825-2477
Mailing Address - Fax:
Practice Address - Street 1:3601 W DEVON AVE STE 106
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-1216
Practice Address - Country:US
Practice Address - Phone:312-825-2477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-18
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty