MEDICARE: GLORY HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1184354425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLORY HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	12032 N PENNSYLVANIA AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-7827
Country	:	US
Telephone Number	:	405-907-4929
Fax Number	:

Provider Business Practice Location Address
First Line	:	12032 N PENNSYLVANIA AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-7827
Country	:	US
Telephone Number	:	405-907-4929
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHARLES HORNUVO
Credential	:
Telephone Number	:	405-907-4929

Provider Enumeration Date	:	06/10/2022
Last Update Date	:	09/05/2023

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Directions to “GLORY HEALTHCARE LLC ” Practice Location

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