Provider Demographics
NPI:1215674866
Name:GLORIANA HOMECARE LLC
Entity type:Organization
Organization Name:GLORIANA HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DON
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAISIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:813-957-8329
Mailing Address - Street 1:11411 DRIFTING LEAF DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-0002
Mailing Address - Country:US
Mailing Address - Phone:813-957-8329
Mailing Address - Fax:
Practice Address - Street 1:1990 MAIN ST STE 750
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-8000
Practice Address - Country:US
Practice Address - Phone:813-957-8329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care