MEDICARE: GLAM STREAM 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	163WH0200X	Home Health Registered Nurse

General Provider Information

NPI Number	:	1548140635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLAM STREAM LLC

Provider Business Mailing Address
First Line	:	514 MCARTHUR BLVD
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31093-3220
Country	:	US
Telephone Number	:	478-550-6475
Fax Number	:	719-283-7966

Provider Business Practice Location Address
First Line	:	514 MCARTHUR BLVD
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31093-3220
Country	:	US
Telephone Number	:	478-550-6475
Fax Number	:	719-283-7966

Authorized Official
Title or Position	:	OWNER
Name	:	CORA CAMPBELL
Credential	:
Telephone Number	:	478-550-6475

Provider Enumeration Date	:	09/08/2025
Last Update Date	:	09/08/2025

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