Healthcare Provider Details

I. General information

NPI: 1932157708
Provider Name (Legal Business Name): GLENWOOD ESTATE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 04/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MULBERRY ST
INDEPENDENCE KS
67301-2026
US

IV. Provider business mailing address

1000 MULBERRY ST P.O. BOX 627
INDEPENDENCE KS
67301-2026
US

V. Phone/Fax

Practice location:
  • Phone: 620-331-8789
  • Fax: 620-331-6895
Mailing address:
  • Phone: 620-331-8789
  • Fax: 620-331-6895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberN063017
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberN063017
License Number StateKS

VIII. Authorized Official

Name: MARY ANN POLLOCK
Title or Position: OWNER
Credential:
Phone: 620-331-8789