Healthcare Provider Details

I. General information

NPI: 1457742058
Provider Name (Legal Business Name): GLENWOOD HEALTH AND REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2015
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 MOUNTAIN VIEW RD
GLENWOOD AR
71943-9061
US

IV. Provider business mailing address

615 MOUNTAIN VIEW RD
GLENWOOD AR
71943-9061
US

V. Phone/Fax

Practice location:
  • Phone: 870-356-3953
  • Fax: 870-356-4314
Mailing address:
  • Phone: 870-356-3953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number964
License Number StateAR

VIII. Authorized Official

Name: PAULA A LEE
Title or Position: CEO
Credential: NHA
Phone: 870-356-3953