Provider Demographics
NPI:1811468531
Name:GLAMA KERI HOME CARE AGENCY
Entity type:Organization
Organization Name:GLAMA KERI HOME CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:KERUBO
Authorized Official - Last Name:MACHOGU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-200-5200
Mailing Address - Street 1:2738 WINNETKA AVE N # 150Q
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55427-2850
Mailing Address - Country:US
Mailing Address - Phone:952-200-5200
Mailing Address - Fax:
Practice Address - Street 1:2738 WINNETKA AVE N # 150Q
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55427-2850
Practice Address - Country:US
Practice Address - Phone:952-200-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care