Organization
GLORYLAND HEALTHCARE SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AUGUSTINA AGADAGBA ARNP (OWNER)
(918) 813-0511
Entity
Organization
Contact information
Practice address
1312 S GARNETT RD, TULSA, OK 74128-1811
(918) 203-3164
(918) 203-3163
Mailing address
909 S ASTER AVE, BROKEN ARROW, OK 74012-8832
(918) 813-0511
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200498000A
—
OK
Enumeration date
02/04/2019
Last updated
02/04/2019
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