Organization
GLORY DIVINE HOME CARE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEDDRA W HOLMES (ADMINISTRATOR)
(985) 369-4111
Entity
Organization
Contact information
Practice address
4589 A HWY 1, NAPOLEONVILLE, LA 70390
(985) 369-4111
(985) 369-4110
Mailing address
PO BOX 867, NAPOLEONVILLE, LA 70390-0867
(985) 369-4111
(985) 369-4110
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
12505
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1597015
PROVIDER'S NUMBER
LA
Enumeration date
04/04/2007
Last updated
08/22/2020
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