Glory Personal Care Home, LLC

Primary specialty

Adult CompanionTaxonomy code 372600000X

License

RN 188675 Issued in GA

Legal business name

GLORY PERSONAL CARE HOME, LLC

Practice address

90 Paces LNDG
Covington, GA 30016-4167

Phone

(678) 432-8818

NPI assigned

Nov 1, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Syvis A Rodgers

Title

Director

Phone

(678) 342-8818

Specialties & licenses 2

Addresses

Other identifiers 3

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1288569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288569600000",
    "number": "1063712487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 PACES LNDG",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300164167",
            "telephone_number": "678-432-8818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 PACES LNDG",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300164167",
            "telephone_number": "678-432-8818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLORY PERSONAL CARE HOME, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-01",
        "last_updated": "2010-11-01",
        "status": "A",
        "authorized_official_last_name": "RODGERS",
        "authorized_official_first_name": "SYVIS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "678-342-8818",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "372600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Adult Companion",
            "state": "GA",
            "license": "RN 188675",
            "primary": true
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "GA",
            "license": "RN 188675",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEWTON COUNTY BUSINESS LICENSE",
            "identifier": "BLC10-17496",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEORGIA DEPARTMENT OF COMMUNITY HEALTH",
            "identifier": "107-01-0829",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGISTERED NURSE LICENSE",
            "identifier": "RN188675",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Adult Companion in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.