MEDICARE: GLORIOUS HOME HELP CARE AND MIHP

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	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1487137410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLORIOUS HOME HELP CARE AND MIHP

Provider Business Mailing Address
First Line	:	4640 AUDUBON RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48224-2797
Country	:	US
Telephone Number	:	313-525-1489
Fax Number	:

Provider Business Practice Location Address
First Line	:	4640 AUDUBON RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48224-2797
Country	:	US
Telephone Number	:	313-525-1489
Fax Number	:

Authorized Official
Title or Position	:	COORDINATOR
Name	:	SARITA COLLINS-HARPER
Credential	:	RN
Telephone Number	:	313-525-1489

Provider Enumeration Date	:	09/14/2018
Last Update Date	:	09/14/2018

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