Provider Demographics
NPI:1134925951
Name:GLORIOUS EAGLES LLC
Entity type:Organization
Organization Name:GLORIOUS EAGLES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMSON
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAYANDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-263-6291
Mailing Address - Street 1:2119 110TH LN NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-4173
Mailing Address - Country:US
Mailing Address - Phone:651-263-6291
Mailing Address - Fax:
Practice Address - Street 1:2119 110TH LN NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-4173
Practice Address - Country:US
Practice Address - Phone:651-263-6291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency