Healthcare Provider Details

I. General information

NPI: 1245379593
Provider Name (Legal Business Name): GLORY FIRST FAMILY CARE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 06/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 ATKINSON ST
LAURINBURG NC
28352-4723
US

IV. Provider business mailing address

1112 ATKINSON ST P.O. BOX 1134
LAURINBURG NC
28352-4723
US

V. Phone/Fax

Practice location:
  • Phone: 910-277-2563
  • Fax: 910-277-2564
Mailing address:
  • Phone: 910-277-2563
  • Fax: 910-277-2564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: MRS. GLORI J DAVIS
Title or Position: DIRECTOR
Credential:
Phone: 910-277-2563