Provider Demographics
NPI:1730808031
Name:GLORIOUS ORGANIZATION LLC
Entity type:Organization
Organization Name:GLORIOUS ORGANIZATION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MIRABEL
Authorized Official - Middle Name:ANGUM
Authorized Official - Last Name:FONJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-501-5142
Mailing Address - Street 1:113 MUENSTER DR
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-5780
Mailing Address - Country:US
Mailing Address - Phone:512-642-9088
Mailing Address - Fax:512-672-6147
Practice Address - Street 1:113 MUENSTER DR
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-5780
Practice Address - Country:US
Practice Address - Phone:512-642-9088
Practice Address - Fax:512-672-6147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-22
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)