Provider Demographics
NPI:1932665767
Name:GLORY CARE LLC
Entity Type:Organization
Organization Name:GLORY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MURLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:DESTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-705-3013
Mailing Address - Street 1:18800 NW 2ND AVE STE 219B
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4044
Mailing Address - Country:US
Mailing Address - Phone:305-978-8495
Mailing Address - Fax:
Practice Address - Street 1:18800 NW 2ND AVE STE 219B
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-4044
Practice Address - Country:US
Practice Address - Phone:305-978-8495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-18
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health