Provider Demographics
NPI:1184381543
Name:GLORIOUS MENTAL HEALTH
Entity type:Organization
Organization Name:GLORIOUS MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOSIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FELUDU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-618-9748
Mailing Address - Street 1:112 MISTY DALE WAY
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-1802
Mailing Address - Country:US
Mailing Address - Phone:240-618-9748
Mailing Address - Fax:
Practice Address - Street 1:112 MISTY DALE WAY
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1802
Practice Address - Country:US
Practice Address - Phone:240-618-9748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251J00000XAgenciesNursing CareGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient