Provider Demographics
NPI:1780467985
Name:GLORY DEW
Entity type:Organization
Organization Name:GLORY DEW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OCHO ROLAND
Authorized Official - Middle Name:JOCE
Authorized Official - Last Name:OHOMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:475-287-9731
Mailing Address - Street 1:100 LEETE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-5366
Mailing Address - Country:US
Mailing Address - Phone:475-287-9731
Mailing Address - Fax:
Practice Address - Street 1:100 LEETE ST APT 3
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-5366
Practice Address - Country:US
Practice Address - Phone:475-287-9731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty