GLORY PERSONAL CARE HOME, LLC (NPI# 1063712487) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063712487 |
| Entity Type | Organization |
| Organization Name | GLORY PERSONAL CARE HOME, LLC |
| Practice Address |
90 Paces Lndg Covington GA 30016-4167 |
| Practice Telephone | 6784328818 |
| Mailing Telephone | 6784328818 |
| Enumeration Date | 2010-11-01 |
| Last Update Date | 2010-11-01 |
| Authorized Official Name | MRS. SYVIS A RODGERS (DIRECTOR) |
| Authorized Official Telephone | 6783428818 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 385H00000X | Respite Care | RN 188675 | GA | Respite Care Facility |
| Y | 372600000X | Adult Companion | RN 188675 | GA | Nursing Service Related Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | GEORGIA DEPARTMENT OF COMMUNITY HEALTH | 107-01-0829 | 01 |
| GA | REGISTERED NURSE LICENSE | RN188675 | 01 |
| GA | NEWTON COUNTY BUSINESS LICENSE | BLC10-17496 | 01 |
| Street Address |
90 PACES LNDG |
| City | COVINGTON |
| State | GA |
| Zip Code | 30016-4167 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013565605 | Katrina Williams | Case Manager/Care Coordinator | 220 Meadowidge Dr, Covington, GA 30016 | 2019-08-28 |
| 1407322134 | Mali Rice | Registered Nurse | 105 Syracuse Lane, Covington, GA 30016 | 2018-10-20 |
| 1619452927 | Angelina Jones | Contractor | 290 Piedmont Circle, Covington, GA 30016 | 2018-10-02 |
| 1881116721 | Springhill Manor Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 600 Spring Hill Drive, Covington, GA 30016 | 2017-07-12 |
| 1922538529 | Tisha Owes | Home Health | 110 Trinity Dr, Covington, GA 30016 | 2017-06-15 |
| 1053868695 | Delhia Assanah IIi | Counselor | 101 Kirkland Road, Covington, GA 30016 | 2016-09-01 |
| 1760834295 | Resurgens East Surgery Center, LLC | Clinic/Center | 3241 Iris Dr, Suite 100, Covington, GA 30016 | 2016-07-08 |
| 1528443371 | Latoya N Wright | Counselor | 100 Winnstead Place, Covington, GA 30016 | 2015-07-22 |
| 1598157307 | Sierra Private Homecare, Inc. | Adult Companion | 75 Cinnamon Oak Circle, Covington, GA 30016 | 2015-03-03 |
| 1326391079 | Lana Abiola Fraser | Nurse's Aide | 840 Oakhill Road, Covington, GA 30016 | 2012-10-18 |
| Find all providers in zip 30016 | ||||
| Taxonomy Code | 372600000X |
| Grouping | Nursing Service Related Providers |
| Classification | Adult Companion |
| An individual who provides supervision, socialization, and non-medical care to a functionally impaired adult. Companions may assist or supervise the individual with such tasks as meal preparation, laundry and shopping, but do not perform these activities as discrete services. These services are provided in accordance with a therapeutic goal in the plan of care. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598157307 | Sierra Private Homecare, Inc. | Adult Companion | 75 Cinnamon Oak Circle, Covington, GA 30016 | 2015-03-03 |
| 1720389885 | Christopher Wilfred Martin | Adult Companion | 135 Pebble Ridge Dr, Covington, GA 30014-4400 | 2010-11-05 |
| 1891994745 | Fay A Laing | Adult Companion | 660 Kirkland Rd, Covington, GA 30016-3316 | 2007-07-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548861156 | Angela Emanuel Morris | Adult Companion | 3805 Bayside Psge Nw, Acworth, GA 30101-4384 | 2020-11-02 |
| 1194330787 | Quanisha Aliyah Vera | Adult Companion | 3805 Nicoll Dr, Augusta, GA 30906-9242 | 2020-09-10 |
| 1720690852 | Shermaine Demetric Cleveland | Adult Companion | 1508 Teakwood Dr, Griffin, GA 30223-1062 | 2020-08-19 |
| 1780202960 | Shabaka Fletcher | Adult Companion | 901 Stoneview Trl Nw, Lilburn, GA 30047-7127 | 2020-07-14 |
| 1235747403 | Abundant Heart Healthcare Solution, LLC | Adult Companion | 6361 Talokas Lane, Ste C 140-279, Columbus, GA 31909 | 2020-07-14 |
| 1447878020 | Shanta Lafaye Watkins | Adult Companion | 103 Ashlund Dr, Centerville, GA 31028-1262 | 2020-07-09 |
| 1437775764 | The Maines Group, LLC | Adult Companion | The Maines Group, LLC Dba Maines Health and Wellness, 3461 Jessica Run, Decatur, GA 30034 | 2020-06-23 |
| 1174146682 | Atrianon, LLC | Adult Companion | 9048 River Bend Ct, Villa Rica, GA 30180-4157 | 2020-05-19 |
| 1811518616 | Laquinta A Hutchins | Adult Companion | 7684 Bernardo Dr, Riverdale, GA 30296-7191 | 2020-05-03 |
| 1932737046 | Samagas House Org | Adult Companion | 1500 Mountain View Cirlcle, Conyers, GA 30014 | 2020-04-01 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.