Healthcare Provider Details

I. General information

NPI: 1114254653
Provider Name (Legal Business Name): GLENCARE ASSISTED LIVING, INC DBA GLENCARE OF SNOW HILL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2009
Last Update Date: 11/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 LIMESTONE RD
KENANSVILLE NC
28349-9031
US

IV. Provider business mailing address

PO BOX 339
KENANSVILLE NC
28349-0339
US

V. Phone/Fax

Practice location:
  • Phone: 910-275-0058
  • Fax: 910-275-0093
Mailing address:
  • Phone: 910-275-0058
  • Fax: 910-275-0093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANNE KORNEGAY
Title or Position: VICE PRESIDENT
Credential: RN
Phone: 910-275-0058