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General NPI Number Information
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NPI Number | 1174881189
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Entity Type | Organization
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Legal Business Name | GOD'S GLORY
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Dates
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Enumeration Date | 04/26/2012
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Last Update Date | 09/24/2013
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Provider Practice Location Address
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Address Line | 5934 TORRESDALE AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19135-4151
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Country | US
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Telephone | 267-339-2684
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Fax |
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Provider Business Mailing Address
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Address Line | 5934 TORRESDALE AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19135-4151
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Country | US
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Telephone | 267-339-2684
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | MRS. ADEJOKE OLAYEMI JOHNSON
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Credential | BSC HONS
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Telephone | 267-339-2684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 22563601
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License Number State | PA
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