Provider Demographics
NPI:1922884451
Name:GLORY HOMECARE SERVICES LLC
Entity Type:Organization
Organization Name:GLORY HOMECARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-867-2564
Mailing Address - Street 1:4208 EVERGREEN LN STE 225
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3251
Mailing Address - Country:US
Mailing Address - Phone:703-867-2564
Mailing Address - Fax:
Practice Address - Street 1:4208 EVERGREEN LN STE 225
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3251
Practice Address - Country:US
Practice Address - Phone:703-867-2564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care