Provider Demographics
NPI:1003661042
Name:GLORIOUS BUSINESS ENTERPRISE LLC
Entity type:Organization
Organization Name:GLORIOUS BUSINESS ENTERPRISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:313-802-0766
Mailing Address - Street 1:29488 WOODWARD AVE # 326
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-0903
Mailing Address - Country:US
Mailing Address - Phone:313-802-0766
Mailing Address - Fax:313-863-2563
Practice Address - Street 1:18204 GREENLAWN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-2107
Practice Address - Country:US
Practice Address - Phone:313-802-0766
Practice Address - Fax:313-863-2563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No305S00000XManaged Care OrganizationsPoint of Service