MEDICARE: GLORIOUS DAYS PERSONAL CARE HOME INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320800000X	Mental Illness Community Based Residential Treatment Facility
2	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1073790531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLORIOUS DAYS PERSONAL CARE HOME INC.

Provider Business Mailing Address
First Line	:	1706 GELLHORN DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77029-3347
Country	:	US
Telephone Number	:	713-674-1168
Fax Number	:	713-674-1168

Provider Business Practice Location Address
First Line	:	1706 GELLHORN DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77029-3347
Country	:	US
Telephone Number	:	713-674-1168
Fax Number	:	713-674-1168

Authorized Official
Title or Position	:	ADMINISTRATOR713
Name	:	MISS MARILYN GALE JONES
Credential	:	MANAGER
Telephone Number	:	713-674-1168

Provider Enumeration Date	:	01/28/2008
Last Update Date	:	01/28/2008

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