Provider Demographics
NPI:1174881189
Name:GOD'S GLORY
Entity type:Organization
Organization Name:GOD'S GLORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADEJOKE
Authorized Official - Middle Name:OLAYEMI
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:BSC HONS
Authorized Official - Phone:267-339-2684
Mailing Address - Street 1:5934 TORRESDALE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19135-4151
Mailing Address - Country:US
Mailing Address - Phone:267-339-2684
Mailing Address - Fax:
Practice Address - Street 1:5934 TORRESDALE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135-4151
Practice Address - Country:US
Practice Address - Phone:267-339-2684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA22563601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care