Healthcare Provider Details

I. General information

NPI: 1245400910
Provider Name (Legal Business Name): GLORY ASSISTED ;LIVING FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2008
Last Update Date: 03/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7221 UDINE AVE
ORLANDO FL
32819-8446
US

IV. Provider business mailing address

7221 UDINE AVE
ORLANDO FL
32819-8446
US

V. Phone/Fax

Practice location:
  • Phone: 407-432-3404
  • Fax:
Mailing address:
  • Phone: 407-432-3404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateFL

VIII. Authorized Official

Name: MISS DELPHANIE MELBOURNE
Title or Position: OWNER/ ADMINISTRATOR
Credential:
Phone: 407-432-3404