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General NPI Number Information
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NPI Number | 1083509046
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Entity Type | Organization
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Legal Business Name | GLOW BEHAVIORAL SERVICES
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Dates
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Enumeration Date | 06/10/2025
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 3712 ISLA VISTA CT
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City | MADERA
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State | CA
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Zip | 93637-3314
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Country | US
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Telephone | 559-975-3299
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Fax |
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Provider Business Mailing Address
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Address Line | 8605 SANTA MONICA BLVD # 552856
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90069-4109
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | KAYLEIGH RIDER
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Credential |
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Telephone | 866-559-4569
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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