| Glory Mental Health A Professional Nursing Corporation | |
|
2501 E Chapman Ave Ste 106 Fullerton CA 92831-3135 | |
| (805) 886-5200 | |
| Not Available |
| Full Name | Glory Mental Health A Professional Nursing Corporation |
|---|---|
| Speciality | Clinic/Center |
| Location | 2501 E Chapman Ave Ste 106, Fullerton, California |
| Authorized Official Name and Position | Juyeon Shin (CEO) |
| Authorized Official Contact | 8058865200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Glory Mental Health A Professional Nursing Corporation 2501 E Chapman Ave Ste 106 Fullerton CA 92831-3135 Ph: () - | Glory Mental Health A Professional Nursing Corporation 2501 E Chapman Ave Ste 106 Fullerton CA 92831-3135 Ph: (805) 886-5200 |
| NPI Number | 1619740859 |
|---|---|
| Provider Enumeration Date | 10/31/2023 |
| Last Update Date | 05/03/2024 |
| Certification Date | 05/03/2024 |
| Medicare PECOS PAC ID | 3870035157 |
|---|---|
| Medicare Enrollment ID | O20240603002674 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619740859 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Juyeon Shin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093171696 PECOS PAC ID: 2466742408 Enrollment ID: I20240603003794 |
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