Provider Demographics
NPI:1881134013
Name:GLORIAS HOME
Entity type:Organization
Organization Name:GLORIAS HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:PEGUES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-831-2423
Mailing Address - Street 1:7117 MILLERS GLEN WAY
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-4179
Mailing Address - Country:US
Mailing Address - Phone:901-831-2423
Mailing Address - Fax:
Practice Address - Street 1:3035 DIRECTORS ROW # 311
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38131-0420
Practice Address - Country:US
Practice Address - Phone:901-831-2423
Practice Address - Fax:901-800-1752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-07
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP316596251J00000X
TN311Z00000X
347C00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No347C00000XTransportation ServicesPrivate Vehicle