MEDICARE: GLORY HOME HEALTH CARE 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1548853088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLORY HOME HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	4126 N 90TH CT
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-1603
Country	:	US
Telephone Number	:	414-758-4309
Fax Number	:

Provider Business Practice Location Address
First Line	:	4126 N 90TH CT
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-1603
Country	:	US
Telephone Number	:	414-758-4309
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JULIE VANG
Credential	:
Telephone Number	:	414-758-4309

Provider Enumeration Date	:	02/16/2021
Last Update Date	:	02/16/2021

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Directions to “GLORY HOME HEALTH CARE LLC ” Practice Location

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