# GLORYHOUSE ILP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093302291
- **Authorized official:** CYNTHIA JACKSON (OWNER)
- **Authorized official phone:** (225) 614-8960

## Contact information

- **Practice address:** 3173 WASHINGTON AVE, BATON ROUGE, LA 70802-2178
- **Practice address phone:** (225) 778-7678
- **Practice address fax:** (225) 341-6825
- **Mailing address:** 3173 WASHINGTON AVE, BATON ROUGE, LA 70802-2178
- **Mailing address phone:** (225) 778-7678

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QC1500X | Community Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/22/2020
- **Last updated:** 12/22/2020