Healthcare Provider Details

I. General information

NPI: 1649628769
Provider Name (Legal Business Name): GLEM HEALTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2016
Last Update Date: 05/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 S DUNCAN DR
TAVARES FL
32778-4044
US

IV. Provider business mailing address

21701 ROLLINGWOOD TRL
EUSTIS FL
32736-9751
US

V. Phone/Fax

Practice location:
  • Phone: 352-835-0101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number299994223
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number233221
License Number StateFL

VIII. Authorized Official

Name: GLENN FECHTENBURG
Title or Position: PRESIDENT
Credential: RN
Phone: 352-835-0101