Healthcare Provider Details

I. General information

NPI: 1104715614
Provider Name (Legal Business Name): NEW GLORY HEALTH SYSTEM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 LORD BALTIMORE DR STE 105
WINDSOR MILL MD
21244-5801
US

IV. Provider business mailing address

3104 LORD BALTIMORE DR STE 105
BALTIMORE MD
21244-5801
US

V. Phone/Fax

Practice location:
  • Phone: 410-725-2324
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. AUGUSTINE JACOBSON
Title or Position: CEO
Credential:
Phone: 410-725-2324