# GLORY VISITING PHYSICIAN PC.

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

## Provider details

- **NPI number:** 1669672705
- **Authorized official:** DR. CHARISE LANETTE VALENTINE M. D. (NEUROLOGIST)
- **Authorized official phone:** (248) 569-5476

## Contact information

- **Practice address:** 4245 S BEECH DALY ST, DEARBORN HTS, MI 48125-1567
- **Practice address phone:** (248) 569-5476
- **Practice address fax:** (248) 424-8987
- **Mailing address:** 30063 RAMBLING RD, SOUTHFIELD, MI 48076-1038
- **Mailing address phone:** (248) 569-5476
- **Mailing address fax:** (248) 424-8987

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320700000X | Physical Disabilities Residential Treatment Facility | 4301053752 | MI | Yes |

## Other

- **Enumeration date:** 07/18/2007
- **Last updated:** 06/08/2015