Healthcare Provider Details

I. General information

NPI: 1073790531
Provider Name (Legal Business Name): GLORIOUS DAYS PERSONAL CARE HOME INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 GELLHORN DR
HOUSTON TX
77029-3347
US

IV. Provider business mailing address

1706 GELLHORN DR
HOUSTON TX
77029-3347
US

V. Phone/Fax

Practice location:
  • Phone: 713-674-1168
  • Fax: 713-674-1168
Mailing address:
  • Phone: 713-674-1168
  • Fax: 713-674-1168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MISS MARILYN GALE JONES
Title or Position: ADMINISTRATOR713
Credential: MANAGER
Phone: 713-674-1168