Provider Demographics
NPI:1851007355
Name:GLORIOUS LIVING & CARE INC
Entity Type:Organization
Organization Name:GLORIOUS LIVING & CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DICKSON
Authorized Official - Middle Name:
Authorized Official - Last Name:IRIOGBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-516-5669
Mailing Address - Street 1:4170 GLAD MORNING DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH FULTON
Mailing Address - State:GA
Mailing Address - Zip Code:30349-3901
Mailing Address - Country:US
Mailing Address - Phone:615-516-5669
Mailing Address - Fax:
Practice Address - Street 1:4170 GLAD MORNING DR
Practice Address - Street 2:
Practice Address - City:SOUTH FULTON
Practice Address - State:GA
Practice Address - Zip Code:30349-3901
Practice Address - Country:US
Practice Address - Phone:615-516-5669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
251E00000XOtherHOME HEALTHCARE AGENCY