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General NPI Number Information
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NPI Number | 1912671975
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Entity Type | Organization
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Legal Business Name | GLORIOUS IN HOME AND CDS LLC
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Dates
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Enumeration Date | 08/04/2021
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Last Update Date | 08/05/2021
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Provider Practice Location Address
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Address Line | 1011B TRUMAN BLVD
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City | CARUTHERSVILLE
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State | MO
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Zip | 63830
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Country | US
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Telephone | 573-620-3186
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Fax | 573-333-9898
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Provider Business Mailing Address
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Address Line | PO BOX 1060
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City | CARUTHERSVILLE
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State | MO
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Zip | 63830-1060
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Country | US
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Telephone | 573-333-1300
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Fax | 573-333-9898
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Authorized Official
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Title or Position | MEMBER
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Name | MR. ELISHA S PULLEN
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Credential |
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Telephone | 573-620-3186
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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 |
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License Number State |
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