Healthcare Provider Details

I. General information

NPI: 1063409647
Provider Name (Legal Business Name): GLENWOOD VILLAGE CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 2ND ST SE
GLENWOOD MN
56334-1810
US

IV. Provider business mailing address

719 2ND ST SE
GLENWOOD MN
56334-1810
US

V. Phone/Fax

Practice location:
  • Phone: 320-634-5131
  • Fax: 320-634-5777
Mailing address:
  • Phone: 320-634-5131
  • Fax: 320-634-5777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateMN

VIII. Authorized Official

Name: MARNIE MARIE GUGISBERG
Title or Position: CFO
Credential:
Phone: 320-763-1164