Provider Demographics
NPI:1184492951
Name:GLORIA DIVINE ANGELS
Entity type:Organization
Organization Name:GLORIA DIVINE ANGELS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHIQUITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLENDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-900-8524
Mailing Address - Street 1:108 COURT SQ
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MS
Mailing Address - Zip Code:39051-4114
Mailing Address - Country:US
Mailing Address - Phone:601-900-8524
Mailing Address - Fax:
Practice Address - Street 1:108 COURT SQ
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MS
Practice Address - Zip Code:39051-4114
Practice Address - Country:US
Practice Address - Phone:601-654-2130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health