Organization
GLORYHOUSE ILP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA JACKSON (OWNER)
(225) 614-8960
Entity
Organization
Contact information
Practice address
3173 WASHINGTON AVE, BATON ROUGE, LA 70802-2178
(225) 778-7678
(225) 341-6825
Mailing address
3173 WASHINGTON AVE, BATON ROUGE, LA 70802-2178
(225) 778-7678
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
—
—
Other
Enumeration date
12/22/2020
Last updated
12/22/2020
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