Healthcare Provider Details

I. General information

NPI: 1740712801
Provider Name (Legal Business Name): GLORIOUS HOME CARE & NURSING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 HURON AVE
EGG HARBOR TOWNSHIP NJ
08234-7320
US

IV. Provider business mailing address

110 HURON AVE
EGG HARBOR TOWNSHIP NJ
08234-7320
US

V. Phone/Fax

Practice location:
  • Phone: 609-904-6911
  • Fax:
Mailing address:
  • Phone: 609-904-6911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHPO239900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberHPO239900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberHPO239900
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHPO239900
License Number StateNJ

VIII. Authorized Official

Name: MR. KOFI A IDAN
Title or Position: CEO & EXECUTIVE CHAIRMAN
Credential: MFIN,MBA
Phone: 484-557-0913