Healthcare Provider Details

I. General information

NPI: 1881204352
Provider Name (Legal Business Name): GLAMOUR HOMECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2020
Last Update Date: 08/08/2020
Certification Date: 08/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 CENTRAL PARK BLVD STE 200
FREDERICKSBURG VA
22401-4953
US

IV. Provider business mailing address

PO BOX 952
GAINESVILLE VA
20156-0952
US

V. Phone/Fax

Practice location:
  • Phone: 576-662-1064
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SHAVONNAH UPCHURCH
Title or Position: OWNER
Credential:
Phone: 571-662-1064