Provider Demographics
NPI:1952898371
Name:EDDIE MARIE GLOVER
Entity Type:Organization
Organization Name:EDDIE MARIE GLOVER
Other - Org Name:GLOVERS FOSTER HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-461-8158
Mailing Address - Street 1:12349 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:MANOR
Mailing Address - State:TX
Mailing Address - Zip Code:78653-3620
Mailing Address - Country:US
Mailing Address - Phone:512-461-8158
Mailing Address - Fax:
Practice Address - Street 1:12349 JOHNSON RD
Practice Address - Street 2:
Practice Address - City:MANOR
Practice Address - State:TX
Practice Address - Zip Code:78653-3620
Practice Address - Country:US
Practice Address - Phone:512-461-8158
Practice Address - Fax:888-311-7675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-20
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX148669310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility