Organization
GLORY PERSONAL CARE HOME, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SYVIS A RODGERS (DIRECTOR)
(678) 342-8818
Entity
Organization
Contact information
Practice address
90 PACES LNDG, COVINGTON, GA 30016-4167
(678) 432-8818
Mailing address
90 PACES LNDG, COVINGTON, GA 30016-4167
(678) 432-8818
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
RN 188675
GA
385H00000X
Respite Care
RN 188675
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107-01-0829
GEORGIA DEPARTMENT OF COMMUNITY HEALTH
GA
01
—
BLC10-17496
NEWTON COUNTY BUSINESS LICENSE
GA
01
—
RN188675
REGISTERED NURSE LICENSE
GA
Enumeration date
11/01/2010
Last updated
11/01/2010
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