Provider Demographics
NPI:1912671975
Name:GLORIOUS IN HOME AND CDS LLC
Entity Type:Organization
Organization Name:GLORIOUS IN HOME AND CDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ELISHA
Authorized Official - Middle Name:S
Authorized Official - Last Name:PULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-620-3186
Mailing Address - Street 1:PO BOX 1060
Mailing Address - Street 2:
Mailing Address - City:CARUTHERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63830-1060
Mailing Address - Country:US
Mailing Address - Phone:573-333-1300
Mailing Address - Fax:573-333-9898
Practice Address - Street 1:1011B TRUMAN BLVD
Practice Address - Street 2:
Practice Address - City:CARUTHERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63830
Practice Address - Country:US
Practice Address - Phone:573-620-3186
Practice Address - Fax:573-333-9898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-04
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health