1326368044 NPI number — INCO GLORY HEALTHCARE INC.

Table of content: (NPI 1326368044)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326368044 NPI number — INCO GLORY HEALTHCARE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INCO GLORY HEALTHCARE INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326368044
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 496043
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75049-6043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-918-2557
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1014 LOBLOLLY PINE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76012-2527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-918-2557
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/04/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
UDJE
Authorized Official First Name:
IBUKUN
Authorized Official Middle Name:
NATHANIEL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
601-918-2557

Provider Taxonomy Codes

  • Taxonomy code: 251J00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 347C00000X , with the licence number: VLL729 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1326368044 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".