Healthcare Provider Details

I. General information

NPI: 1780924639
Provider Name (Legal Business Name): GLACIER HILLS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 EARHART RD
ANN ARBOR MI
48105-2768
US

IV. Provider business mailing address

1200 EARHART RD
ANN ARBOR MI
48105-2768
US

V. Phone/Fax

Practice location:
  • Phone: 734-929-6721
  • Fax: 734-213-9180
Mailing address:
  • Phone: 734-929-6721
  • Fax: 734-213-9180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: PAMELA SUE LATOVICK
Title or Position: VP REIMBURSEMENT
Credential:
Phone: 734-343-6628