Healthcare Provider Details

I. General information

NPI: 1477511079
Provider Name (Legal Business Name): GLENBRIDGE HEALTH AND REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 08/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 MILTON BROWN HEIRS RD
BOONE NC
28607-8708
US

IV. Provider business mailing address

211 MILTON BROWN HEIRS RD
BOONE NC
28607-8708
US

V. Phone/Fax

Practice location:
  • Phone: 828-264-6720
  • Fax: 828-264-9023
Mailing address:
  • Phone: 828-264-6720
  • Fax: 828-264-9023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0400
License Number StateNC

VIII. Authorized Official

Name: MR. KENNETH NIELSON
Title or Position: MANAGING MEMBER
Credential: MBA
Phone: 407-247-2788