MEDICARE: GLORY ASSISTED ;LIVING FACILITY

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	310400000X	Assisted Living Facility		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245400910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLORY ASSISTED ;LIVING FACILITY

Provider Business Mailing Address
First Line	:	7221 UDINE AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-8446
Country	:	US
Telephone Number	:	407-432-3404
Fax Number	:

Provider Business Practice Location Address
First Line	:	7221 UDINE AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-8446
Country	:	US
Telephone Number	:	407-432-3404
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ ADMINISTRATOR
Name	:	MISS DELPHANIE MELBOURNE
Credential	:
Telephone Number	:	407-432-3404

Provider Enumeration Date	:	03/09/2008
Last Update Date	:	03/09/2008

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