Provider Demographics
NPI:1922642107
Name:GLORY DAYS, LLC DBA OLD GLORY DAYS
Entity Type:Organization
Organization Name:GLORY DAYS, LLC DBA OLD GLORY DAYS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SLATTERY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:203-648-5983
Mailing Address - Street 1:107 CHURCH HILL RD STE GL1
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482-1194
Mailing Address - Country:US
Mailing Address - Phone:203-648-5983
Mailing Address - Fax:
Practice Address - Street 1:107 CHURCH HILL RD STE GL1
Practice Address - Street 2:
Practice Address - City:SANDY HOOK
Practice Address - State:CT
Practice Address - Zip Code:06482-1194
Practice Address - Country:US
Practice Address - Phone:203-648-5983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care