Healthcare Provider Details

I. General information

NPI: 1578851796
Provider Name (Legal Business Name): GLO'S KIDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 S 8TH ST
MONROE LA
71202-2909
US

IV. Provider business mailing address

1405 S 8TH ST
MONROE LA
71202-2909
US

V. Phone/Fax

Practice location:
  • Phone: 318-512-3782
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JEREMY BURRELL
Title or Position: CEO
Credential:
Phone: 318-512-3782