# GLORYLAND NURSING REHABILITATION CENTER, LLC

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

## Provider details

- **NPI number:** 1730413683
- **Authorized official:** MR. JOSEPH KOBLA TETTEYCAMBRIDGE PRESIDENT (PRESIDENT)
- **Authorized official phone:** (571) 294-2826

## Contact information

- **Practice address:** 807 K ST NE, WASHINGTON, DC 20002-3636
- **Practice address phone:** (571) 294-2826
- **Practice address fax:** (866) 703-5268
- **Mailing address:** 807 K ST NE, WASHINGTON, DC 20002-3636
- **Mailing address phone:** (517) 294-2826
- **Mailing address fax:** (866) 703-5268

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | DC | Yes |

## Other

- **Enumeration date:** 09/24/2009
- **Last updated:** 09/24/2009