Healthcare Provider Details

I. General information

NPI: 1265956064
Provider Name (Legal Business Name): GLENNON PLACE MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 10/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 N HARDESTY AVE
KANSAS CITY MO
64123-1404
US

IV. Provider business mailing address

4655 W CHASE AVE
LINCOLNWOOD IL
60712-1605
US

V. Phone/Fax

Practice location:
  • Phone: 816-241-2020
  • Fax:
Mailing address:
  • Phone: 847-262-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: YOSEF MEYSTEL
Title or Position: MANAGER
Credential:
Phone: 847-262-3800