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General NPI Number Information
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NPI Number | 1255067310
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Entity Type | Organization
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Legal Business Name | GLORIOUS HOME CARE ASSISTANCE LLC
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Dates
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Enumeration Date | 07/29/2022
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Last Update Date | 07/29/2022
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Provider Practice Location Address
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Address Line | 111 N MARKET ST STE 300
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City | SAN JOSE
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State | CA
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Zip | 95113-1116
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Country | US
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Telephone | 669-295-8659
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Fax |
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Provider Business Mailing Address
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Address Line | 1919 FRUITDALE AVE APT K768
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City | SAN JOSE
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State | CA
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Zip | 95128-4939
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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 | PRESIDENT/CEO
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Name | MINILVA AMUNGWA
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Credential |
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Telephone | 669-295-8659
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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 |
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License Number State |
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