=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790494227
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GLORY HANDS HOME HEALTH CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2022
-----------------------------------------------------
Last Update Date | 11/23/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7777 BONHOMME AVE STE 1838
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63105-1911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-489-6777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7777 BONHOMME AVE STE 1838
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63105-1911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-489-6777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR/OWNER
-----------------------------------------------------
Name | TAMARA DENISE TAYLOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-489-6777
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------