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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
12144
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1597147
PROVIDER'S NUMBER
LA
Enumeration date
04/06/2007
Last updated
08/22/2020
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