Organization
GLORY HEALTHCARE SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BOLANLE OLADUNNI SALAM RN (CEO)
(678) 365-1967
Entity
Organization
Contact information
Practice address
7736 HAMPTON PLACE, SUITE D, LOGANVILLE, GA 30052-6770
(678) 365-1967
(770) 554-6577
Mailing address
PO BOX 390301, SNELLVILLE, GA 30039-0006
(678) 365-1967
(770) 554-6574
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
147-R-0327
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
871127462A
—
GA
Enumeration date
11/06/2007
Last updated
08/16/2010
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