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General NPI Number Information
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NPI Number | 1497147821
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Entity Type | Organization
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Legal Business Name | GLORY DIVINE HEALTH SYSTEMS
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Dates
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Enumeration Date | 02/23/2015
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Last Update Date | 02/23/2015
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Provider Practice Location Address
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Address Line | 6915 VARNUM ST
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City | LANDOVER HILLS
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State | MD
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Zip | 20784-2121
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Country | US
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Telephone | 301-646-2060
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Fax | 301-864-3214
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Provider Business Mailing Address
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Address Line | 9615 VARNUM STREET
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City | LANDOVER
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State | MD
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Zip | 20784-0000
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Country | US
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Telephone | 301-646-2060
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Fax | 301-864-3214
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. ADETUNMBI ADEWAMI
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Credential |
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Telephone | 301-646-2060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | R3482
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License Number State | MD
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