Provider Demographics
NPI:1295245744
Name:GLORY IN WEALTH HOME CARE
Entity type:Organization
Organization Name:GLORY IN WEALTH HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:OLANIYI
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:AJILORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-262-0805
Mailing Address - Street 1:8211 E REGAL PL STE 100
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-7167
Mailing Address - Country:US
Mailing Address - Phone:918-262-0805
Mailing Address - Fax:
Practice Address - Street 1:8211 E REGAL PL STE 100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-7167
Practice Address - Country:US
Practice Address - Phone:918-262-0805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK11111111111111111111Medicaid