Healthcare Provider Details

I. General information

NPI: 1366722761
Provider Name (Legal Business Name): GLORIOUS HOSPICE SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2011
Last Update Date: 08/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 W 61ST AVE
MERRILLVILLE IN
46410-2512
US

IV. Provider business mailing address

250 W 61ST AVE
MERRILLVILLE IN
46410-2512
US

V. Phone/Fax

Practice location:
  • Phone: 219-397-2668
  • Fax:
Mailing address:
  • Phone: 219-397-2668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. GEOFFREY ONYEUKWU
Title or Position: OWNER
Credential: M.D.
Phone: 219-397-2668