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General NPI Number Information
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NPI Number | 1104628221
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Entity Type | Organization
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Legal Business Name | GLM HOUSE INC
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Dates
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Enumeration Date | 03/27/2025
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 4101 UNIVERSITY AVE
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City | SAN DIEGO
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State | CA
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Zip | 92105-1418
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Country | US
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Telephone | 858-609-9073
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1933
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City | LEMON GROVE
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State | CA
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Zip | 91946-1933
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Country | US
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Telephone | 858-609-9073
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. AMELIA BROADNAX
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Credential |
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Telephone | 858-609-9073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 177F00000X
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Taxonomy Name | Lodging Provider
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License Number |
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License Number State |
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