Healthcare Provider Details

I. General information

NPI: 1255632790
Provider Name (Legal Business Name): GLENN MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2010
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 W SYCAMORE ST
WILLOWS CA
95988-2601
US

IV. Provider business mailing address

1133 W SYCAMORE ST
WILLOWS CA
95988-2601
US

V. Phone/Fax

Practice location:
  • Phone: 530-934-1800
  • Fax:
Mailing address:
  • Phone: 530-934-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number23000001
License Number StateCA

VIII. Authorized Official

Name: TAMMY JEAN THOMPSON
Title or Position: VP FINANCE/CFO
Credential:
Phone: 209-287-6308