Provider Demographics
NPI:1962104919
Name:GLORY CARRIERS TRANSPORTATION LLC
Entity type:Organization
Organization Name:GLORY CARRIERS TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/ MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-290-8538
Mailing Address - Street 1:3750 HACKS CROSS RD STE 102-304
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-2367
Mailing Address - Country:US
Mailing Address - Phone:901-290-8538
Mailing Address - Fax:
Practice Address - Street 1:496 QUAIL CREST DR
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-1750
Practice Address - Country:US
Practice Address - Phone:901-290-8538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)