Provider Demographics
NPI:1780083790
Name:GLORY FINANCIAL SERVICES
Entity type:Organization
Organization Name:GLORY FINANCIAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:OLAWUMI
Authorized Official - Middle Name:
Authorized Official - Last Name:OLADEJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-765-2873
Mailing Address - Street 1:210 S MAIN ST
Mailing Address - Street 2:SUITE #5
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-4763
Mailing Address - Country:US
Mailing Address - Phone:469-765-2873
Mailing Address - Fax:
Practice Address - Street 1:320 NORTH ST
Practice Address - Street 2:SUITE #302
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-5017
Practice Address - Country:US
Practice Address - Phone:469-765-3959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GLORY FINANCIAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1861637548Medicaid
TX1073801437Medicaid