Provider Demographics
NPI:1144523903
Name:GLORIOUS GLOBAL OUTREACH
Entity type:Organization
Organization Name:GLORIOUS GLOBAL OUTREACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:ROZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-740-1653
Mailing Address - Street 1:38025 HERMAN ST
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-1365
Mailing Address - Country:US
Mailing Address - Phone:313-740-1653
Mailing Address - Fax:
Practice Address - Street 1:38025 HERMAN ST
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-1365
Practice Address - Country:US
Practice Address - Phone:313-740-1653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS82003058183104A0625X, 310500000X, 311ZA0620X, 315P00000X
MI310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI310400000XMedicaid
MI310500000XMedicaid
MI315900000XMedicaid
MI101YP1600XMedicaid
MI315900000XMedicaid
MI310400000XMedicaid
MI101YP1600XMedicaid
MI310500000XMedicare Oscar/Certification