Healthcare Provider Details

I. General information

NPI: 1780354878
Provider Name (Legal Business Name): G.L.O.R.I.A HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 S JEFFERSON AVE
SAINT LOUIS MO
63118-1510
US

IV. Provider business mailing address

2901 S JEFFERSON AVE
SAINT LOUIS MO
63118-1510
US

V. Phone/Fax

Practice location:
  • Phone: 314-323-5143
  • Fax:
Mailing address:
  • Phone: 314-323-5143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. RANCE JOHN MINER
Title or Position: OWNER
Credential:
Phone: 314-323-5143