Provider Demographics
NPI:1780354878
Name:G.L.O.R.I.A HEALTHCARE, LLC
Entity type:Organization
Organization Name:G.L.O.R.I.A HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANCE
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-323-5143
Mailing Address - Street 1:2901 S JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-1510
Mailing Address - Country:US
Mailing Address - Phone:314-323-5143
Mailing Address - Fax:
Practice Address - Street 1:2901 S JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-1510
Practice Address - Country:US
Practice Address - Phone:314-323-5143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health