Healthcare Provider Details

I. General information

NPI: 1144523903
Provider Name (Legal Business Name): GLORIOUS GLOBAL OUTREACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2010
Last Update Date: 12/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38025 HERMAN ST
ROMULUS MI
48174-1365
US

IV. Provider business mailing address

38025 HERMAN ST
ROMULUS MI
48174-1365
US

V. Phone/Fax

Practice location:
  • Phone: 313-740-1653
  • Fax:
Mailing address:
  • Phone: 313-740-1653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberAS8200305818
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License NumberAS8200305818
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberAS8200305818
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License NumberAS8200305818
License Number StateMI

VIII. Authorized Official

Name: MISS BEVERLY JEAN ROZIER
Title or Position: OWNER
Credential:
Phone: 313-740-1653