=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841593449
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A1 BRINGING GLORY HOME SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2010
-----------------------------------------------------
Last Update Date | 11/09/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5610 CRAWFORDSVILLE RD BUILDING 9 SUITE 912
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46224-3714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-757-6004
-----------------------------------------------------
Fax | 317-757-6004
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5610 CRAWFORDSVILLE RD BUILDING 9 SUITE 912
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46224-3714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-757-6004
-----------------------------------------------------
Fax | 317-757-6004
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. GLORIA J MCGREGOR
-----------------------------------------------------
Credential | CEO
-----------------------------------------------------
Telephone | 317-757-6004
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 10-012481-1
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------