Healthcare Provider Details

I. General information

NPI: 1376155804
Provider Name (Legal Business Name): GLORY FOR LIFE HOME HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5969 E LIVINGSTON AVE STE 201
COLUMBUS OH
43232-2907
US

IV. Provider business mailing address

5969 E LIVINGSTON AVE STE 201
COLUMBUS OH
43232-2907
US

V. Phone/Fax

Practice location:
  • Phone: 717-992-0087
  • Fax:
Mailing address:
  • Phone: 717-992-0087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MS. VIVIAN MBANGOWAH
Title or Position: CEO/MEMBER
Credential:
Phone: 717-992-0087