Provider Demographics
NPI:1881094860
Name:SHEKINAH GLORY LLC
Entity type:Organization
Organization Name:SHEKINAH GLORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:OLUKANNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-450-9827
Mailing Address - Street 1:3805 TABLE ROCK CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-2829
Mailing Address - Country:US
Mailing Address - Phone:757-965-4575
Mailing Address - Fax:
Practice Address - Street 1:3805 TABLE ROCK CT
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-2829
Practice Address - Country:US
Practice Address - Phone:757-965-4575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility