Provider Demographics
NPI:1851569354
Name:GLORY FIRST FAMILY CARE SERVICE, L.L.C.
Entity Type:Organization
Organization Name:GLORY FIRST FAMILY CARE SERVICE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-277-2563
Mailing Address - Street 1:PO BOX 1134
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28353-1134
Mailing Address - Country:US
Mailing Address - Phone:910-277-2563
Mailing Address - Fax:910-277-2564
Practice Address - Street 1:1112 ATKINSON ST
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-4723
Practice Address - Country:US
Practice Address - Phone:910-277-2563
Practice Address - Fax:910-277-2564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management