Healthcare Provider Details

I. General information

NPI: 1558676353
Provider Name (Legal Business Name): GLENWOOD HEALTH AND REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2010
Last Update Date: 06/09/2015
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

1423 CLARKVIEW RD SUITE 500
BALTIMORE MD
21209-2134
US

V. Phone/Fax

Practice location:
  • Phone: 317-841-2377
  • Fax:
Mailing address:
  • Phone: 410-427-2700
  • Fax: 414-815-5558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN K. REYNOLDS
Title or Position: MANAGER
Credential:
Phone: 410-513-8738