Glorious Eagles LLC

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

Legal business name

GLORIOUS EAGLES LLC

Practice address

2119 110TH LN NW
Coon Rapids, MN 55433-4173

Phone

(612) 456-6090

NPI assigned

Jan 9, 2023

Organization subpart

No

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

Authorized official

Name

Prof. Samson Alayande

Title

President

Phone

(612) 456-6090

Specialties & licenses 3

Addresses

Tax ID family

Glorious Eagles LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Glorious Eagles LLC

  • Foster Care Agency
  • Coon Rapids, MN
  • NPI 1134925951
  NPD tax ID

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

{
    "created_epoch": "1673222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691798400000",
    "number": "1184338774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2119 110TH LN NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554334173",
            "telephone_number": "612-456-6090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2119 110TH LN NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554334173",
            "telephone_number": "612-456-6090"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2119 110th Ln NW",
            "address_purpose": "LOCATION",
            "city": "Coon Rapids",
            "state": "MN",
            "postal_code": "554334173",
            "country_code": "US",
            "telephone_number": "612-456-6090",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GLORIOUS EAGLES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-09",
        "last_updated": "2023-08-12",
        "certification_date": "2023-08-12",
        "status": "A",
        "authorized_official_last_name": "ALAYANDE",
        "authorized_official_first_name": "SAMSON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "612-456-6090",
        "authorized_official_name_prefix": "Prof."
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Inga Marie Giske, PMHNP
• Matthew Todd Glaser
• Beth Ann Glasser
• Lisa Niemczyk Glogowski, C.R.N.A
• Glorious Eagles LLC
• Denijal Gluhic
• Elizabeth Godfrey
• Derek Goerke, M.D.
• Luke Goettlicher, LADC
• Gold Pathway PLLC

• Early Intervention Provider Agency in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• Early Intervention Provider Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2023; 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.