Provider Demographics
NPI:1740712801
Name:GLORIOUS HOME CARE & NURSING SERVICES, LLC
Entity type:Organization
Organization Name:GLORIOUS HOME CARE & NURSING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & EXECUTIVE CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:KOFI
Authorized Official - Middle Name:A
Authorized Official - Last Name:IDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MFIN,MBA
Authorized Official - Phone:484-557-0913
Mailing Address - Street 1:110 HURON AVE
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-7320
Mailing Address - Country:US
Mailing Address - Phone:609-904-6911
Mailing Address - Fax:
Practice Address - Street 1:110 HURON AVE
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-7320
Practice Address - Country:US
Practice Address - Phone:609-904-6911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHPO239900251E00000X, 251G00000X, 251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care