Provider Demographics
NPI:1790558971
Name:GLORY DDD SERVICES LLC
Entity Type:Organization
Organization Name:GLORY DDD SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DUDUYEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:SAGAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-603-5168
Mailing Address - Street 1:2052 E LANTANA DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-0290
Mailing Address - Country:US
Mailing Address - Phone:347-603-5168
Mailing Address - Fax:
Practice Address - Street 1:2052 E LANTANA DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-0290
Practice Address - Country:US
Practice Address - Phone:347-603-5168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities