Healthcare Provider Details

I. General information

NPI: 1336963578
Provider Name (Legal Business Name): HSA GLENWOOD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 11/13/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 RIDGEDALE DR
WEST MONROE LA
71291-2017
US

IV. Provider business mailing address

505 N BRAND BLVD STE 1200
GLENDALE CA
91203-3328
US

V. Phone/Fax

Practice location:
  • Phone: 318-329-4525
  • Fax:
Mailing address:
  • Phone: 818-666-0602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: AIMEE GILL
Title or Position: DEPUTY GENERAL COUNSEL
Credential:
Phone: 818-666-0602