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General NPI Number Information
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NPI Number | 1780482620
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Entity Type | Individual
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Provider Name | GLORY AGBOR ENOW
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Gender | Female
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Dates
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Enumeration Date | 03/06/2025
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 3136 TIBURON WAY
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City | LEXINGTON
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State | KY
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Zip | 40511-8672
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Country | US
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Telephone | 859-327-3842
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Fax | 859-201-1449
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Provider Business Mailing Address
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Address Line | 3136 TIBURON WAY
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City | LEXINGTON
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State | KY
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Zip | 40511-8672
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Country | US
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Telephone | 301-683-4421
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Fax | 301-683-4421
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 500430
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License Number State | KY
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